Week 3 Study Guide Flashcards
(24 cards)
What is the first thing you should do after the patient signs in for an appointment
Copy or scan the insurance card on both sides
How do you define medical insurance?
Contract between the individual and the health company. It provides for financial protection for health care cost, in exchange for monthly perineum.
Define the following acronyms and terms:
A. HMO
B. PPO
C. IPA
D. POS
A. Provide comprehensive healthcare with focus on wellness and preventive care
B. The member must select a pcp
C. The providers practice in their own office with their own staff.
D. Plan for members who didn’t select pcp and self refer to a specialist.
What is the name of the health coverage funded by the state and federal government for individuals of limited or low income?
Medicaid
Which insurance covers people over 65 and disabled?
Medicare
What does Tricare cover?
Active service personal, those who died in active duty,
Who are the beneficiaries of CHAMPVA?
Which insurance covers employees who are injured while working?
Workers compensation
What does Indemnity-Type Insurance allows its member to do?
Members are able to see their providers of choice.
What is a cafeteria plan?
The flexible spending arrangement or accounts
When the patient has no insurance coverage and see the doctor, what do you call this type of pay for medical services?
Self pay
The birthday rule is a rule for payment of medical services when both parents of a dependent have insurance coverage. How does this rule work?
The parent whose birthday comes first in the year would be the primary.
What is claim scrubbing?
How are claims tracked?
Who is eligible for Medicare? How many parts does Medicare have?
65 years or older, disabled, or kidney disease.
What does each part of Medicare cover?
4 parts. A. Hospital expenses. B. Out patient and office visits, lab and X-rays. C. Medicare advantage (optional) D. Drugs prescribed
Define Medicare fraud and abuse.
What is coding?
Wha does ICD-10 CM stand for?
International classification of disease. CM stands for clinical modification
What are ICD codes used for?
To code diseases or diagnosis
What is the CPT manual? What is it used for?
Current Procedure Terminology. Used for identifying procedures.
How many sections are in the CPT book?
6 sections. E & M, surgery, lab, X-rays, treatment,
What is a CMS-1500 form?
Claim form.
What is the % of payment (patient responsibility) when a patient is injured on the job (industrial injury)?
0%
