Terms (Jeopardy-style) Flashcards

You may prefer our related Brainscape-certified flashcards:
1
Q

The amount you pay for covered health care services before your insurance plan starts to pay (https://www.healthcare.gov/glossary)

A

Deductible

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2
Q

Insurance program that provides free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities (https://www.healthcare.gov/glossary)

A

Medicaid

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3
Q

A federal health insurance program for people 65 and older and certain younger people with disabilities (https://www.healthcare.gov/glossary)

A

Medicare

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4
Q

A request for payment that you or your health care provider submits to your health insurer when you get items or services you think are covered (https://www.healthcare.gov/glossary)

A

Claim

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5
Q

A fixed amount ($20, for example) you pay for a covered health care service after you’ve paid your deductible (https://www.healthcare.gov/glossary)

A

Copayment (Copay)

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6
Q

A contract that requires your health insurer to pay some or all of your health care costs in exchange for a premium (https://www.healthcare.gov/glossary)

A

Health insurance

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7
Q

Legal entitlement to payment or reimbursement for your health care costs, generally under a contract with a health insurance company, a group health plan offered in connection with employment, or a government program like Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP) (https://www.healthcare.gov/glossary)

A

Health coverage

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8
Q

Your expenses for medical care that aren’t reimbursed by insurance. Includes deductibles, coinsurance, and copayments for covered services plus all costs for services that aren’t covered (https://www.healthcare.gov/glossary)

A

Out-of-pocket costs

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9
Q

A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost (https://www.healthcare.gov/glossary)

A

Preferred Provider Organization (PPO)

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10
Q

An arrangement through your employer that lets you pay for many out-of-pocket medical expenses with tax-free dollars. Allowed expenses include insurance copayments and deductibles, qualified prescription drugs, insulin, and medical devices (https://www.healthcare.gov/glossary)

A

Flexible spending account (FSA)

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11
Q

Services to provide comfort and support for persons in the last stages of a terminal illness and their families (https://www.healthcare.gov/glossary)

A

Hospice

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12
Q

A health problem, like asthma, diabetes, or cancer, you had before the date that new health coverage starts. Insurance companies can’t refuse to cover or charge you more (https://www.healthcare.gov/glossary)

A

Pre-existing condition

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13
Q

The time that must pass before coverage can become effective for an employee or dependent who is otherwise eligible for coverage under a job-based health plan (https://www.healthcare.gov/glossary)

A

Waiting period

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14
Q

The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service (https://www.healthcare.gov/glossary)

A

UCR (Usual, Customary, and Reasonable)

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15
Q

A health care program for active-duty and retired uniformed services members and their families (https://www.healthcare.gov/glossary)

A

TRICARE

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16
Q

A physician that focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions (https://www.healthcare.gov/glossary)

A

Specialist

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17
Q

A written order from your primary care doctor for you to see a specialist or get certain medical services. In many Health Maintenance Organizations (HMOs), necessary before you can get medical care from anyone except your primary care doctor (https://www.healthcare.gov/glossary)

A

Referral

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18
Q

A doctor, hospital or other healthcare provider who is not part of an insurance plan, doctor or hospital network (https://www.healthcare.gov/glossary)

A

Out of network

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19
Q

The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services (https://www.healthcare.gov/glossary)

A

Network

20
Q

A prescription drug that has the same active-ingredient formula as a brand-name drug (https://www.healthcare.gov/glossary)

A

Generic drug

21
Q

A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list (https://www.healthcare.gov/glossary)

A

Formulary

22
Q

A way to figure out who pays first when 2 or more health insurance plans are responsible for paying the same medical claim (https://www.healthcare.gov/glossary)

A

Coordination of benefits

23
Q

The percentage of costs of a covered health care service you pay (20%, for example) after you’ve paid your deductible (https://www.healthcare.gov/glossary)

A

Coinsurance

24
Q

The health care items or services covered under a health insurance plan (https://www.healthcare.gov/glossary)

A

Benefits

25
Q

The maximum amount a plan will pay for a covered health care service. May also be called “eligible expense,” “payment allowance,” or “negotiated rate” (https://www.healthcare.gov/glossary)

A

Allowed amount

26
Q

The doctor who orders your treatment and who is responsible for your care (https://www.uwmedicine.org/patient-resources/billing-and-insurance-2/glossary)

A

Attending physician

27
Q

A surgery performed as an outpatient service (https://www.uwmedicine.org/patient-resources/billing-and-insurance-2/glossary)

A

Same-day surgery

28
Q

existing at or dating from birth (https://www.merriam-webster.com/dictionary)

A

Congenital

29
Q

tissue related

A

histological

30
Q

Insurance program that provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid but not enough to buy private insurance. In some states, covers pregnant women (www.healthcare.gov/glossary)

A

Children’s Health Insurance Program (CHIP)

31
Q

Emergency services you get in an emergency room (www.healthcare.gov/glossary)

A

Emergency room care

32
Q

A requirement that health plans must permit you to enroll regardless of health status, age, gender, or other factors that might predict the use of health services (www.healthcare.gov/glossary)

A

Guaranteed issue

33
Q

A requirement that your health insurance issuer must offer to renew your policy as long as you continue to pay premiums (www.healthcare.gov/glossary)

A

Guaranteed renewal

34
Q

An easy-to-read summary that lets you make apples-to-apples comparisons of costs and coverage between health plans. You can compare options based on price, benefits, and other features that may be important to you (www.healthcare.gov/glossary)

A

Summary of benefits and coverage (SBC)

35
Q

Health care or services provided by hospitals or health care providers that don’t get reimbursed. Often arises when people don’t have insurance and cannot afford to pay the cost of care (www.healthcare.gov/glossary)

A

Uncompensated care

36
Q

A type of dental plan offered through the Marketplace that’s not included as part of a health plan (www.healthcare.gov/glossary)

A

Stand-alone dental plan

37
Q

A drug sold by a drug company under a specific name or trademark and that is protected by a patent (www.healthcare.gov/glossary)

A

Brand name drug

38
Q

Insurance coverage for family members of the policyholder, such as spouses, children, or partners (www.healthcare.gov/glossary)

A

Dependent coverage

39
Q

patient is required to name a primary care physician under this type of plan (“Medical Billing and Coding for Dummies”)

A

HMO

40
Q

languages that make up majority of word parts in medical terms (“Medical Billing and Coding for Dummies”)

A

Greek and Latin

41
Q

used when a procedure is performed on the same day as an E&M visit (“Medical Billing and Coding for Dummies”)

A

Modifier 25

42
Q

used to un-bundle a procedure (https://www.aapc.com)

A

Modifier 59

43
Q

level of code used when patient is getting better (“Medical Billing and Coding for Dummies”)

A

Level-one

44
Q

level of code used when patient isn’t getting better (“Medical Billing and Coding for Dummies”)

A

Level-two

45
Q

level of code used when patient is declining fast (“Medical Billing and Coding for Dummies”)

A

Level-three

46
Q

person who has been officially admitted to the hospital under a physician’s order, until the day before the day of discharge (“Medical Billing and Coding for Dummies”)

A

Inpatient