Unit 1: role of an insurance Agent & Basics of Health Insurance

Question 1

Charging for services done in hospitals, Acute care Hospitals, skilled nursing or long term care facilities, rehabilitation centers, and ambulatory surgical centers.

Answer 1

Facility Billing

Question 2

Charging for services performed by:

Physicians, Non-physician practitioners, Ambulance services, radiology services, and laboratory services

Answer 2

Professional Billing

Question 3

A health care provider who meets state licensing requirements to provide specific medical services.

Answer 3

Non-physician practitioners

Examples:
Physician assistant, nurse practitioner, advanced nurse practitioners, certified nurse anesthetist, physical therapist, speech therapist, licensed clinical social worker, certified registered nurse practitioner

Question 4

An individual who takes a patient to a private area before their visit with the provider to discuss the practices financial policies and review patients insurance coverage

Answer 4

Insurance counselor

Question 5

Type of insurance that provides protection against loss of money caused by failure through ERROR or unintentional OMISSION on the part of the individual or service involved in any aspect of preparation or submission of an insurance claim

Answer 5

Errors omissions insurance

Question 6

A legally enforceable agreement or CONTRACT:

Answer 6

Insurance Contract

Question 7

An individual promising to pay for medical services rendered:

Answer 7

Guarantor

Question 8

5 health insurance policy renewal provisions:

Answer 8

1. Cancel able
2. Optionally renewable
3. Conditionally renewable
4. Guaranteed renewable
5. Non cancel able

Question 9

Insurance reimbursement or payment

Answer 9

Indemnity

Question 10

Under PPACA, health plans must allow employees to keep their children on their health plan until what age?

Answer 10

26 years old

Question 11

A document signed by the insured directing the insurance company to pay BENEFITS directly to the health care organization is known as an:

Answer 11

Assignment benefits

Question 12

A method of making an automatic deposit of funds from the payer into the providers bank account and used in place of a mailed paper check is referred to as:

Answer 12

EFT- Electronic funds tranfer

Question 13

Time limit for filing insurance claims to a commercial carrier may have a range of:

Answer 13

30 days from the date of service to 1 1/2 years