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Felipe Garcia
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Decks in this class (22)
Chapter 1: Coordination of Benefits
Correctly determining the primary...,
If many patients are covered by m...,
The primary health insurance is t...
7
cards
Chapter 1: Medical Necessity
What is the medical necessity,
If a patient tripped on a sidewal...,
If a patient presented with a fev...
4
cards
Chapter 1: Types of Reimbursement
Reimbursement is a term used when...,
What are the 4 common types of he...,
What is free for service ffs reim...
6
cards
Chapter 1: Preauthorization
What is preauthorization method,
Preauthorization requests can be ...,
The term referral can refer to
3
cards
Chapter 2: Terms Related to Policies
The legal contract between an ind...,
What does the policy does,
The cost of the policy is referre...
9
cards
Chapter 2: Who's Who
A person who in whose name the in...,
Other terms for policyholder are,
What are the family members spous...
5
cards
Chapter 2: Terms Related to Payment
What refers to payment received f...,
The health insurance company is k...,
What is a deductible
7
cards
Chapter 3: Commercial Plans
For the most part commercial heal...,
From where doe the patient may re...,
From where does someone can purch...
3
cards
Chapter 3: Government-Sponsored Programs
What are the major categories of ...,
What is medicare,
What is medicaid
10
cards
Chapter 3: Consumer-Driven Health Plans (CDHPs)
Consumer directed health plans ar...,
With the continuing rise in healt...,
Cdhps cost less than traditional ...
10
cards
Chapter 4: Overview of Medicare
What does the federal government ...,
Cms relies on a network of to ser...,
Medicare coverage consists of
8
cards
Chapter 4: Medicare Part A (Hospital Insurance)
What does original medicare includes,
What does medicare part a helps c...,
If the beneficiary or their spous...
7
cards
Chapter 4: Medicare Part B (Hospital Insurance)
Medicare part b cover medically n...,
Does part b covers durable medica...,
Does physical occupational and sp...
10
cards
Chapter 4: Medicare Part C
Medicare part c is also known as,
What is medicare part c,
Unlike original medicare which is...
6
cards
Chapter 4: Medicare Part D
Since original medicare doesn t i...,
Medicare part d is an optional pr...,
Individuals who join a medicare d...
6
cards
Chapter 4: Medicare Reimbursement
Medicare reimburses physicians ba...,
What is the first fee schedule,
What is the second fee schedule
5
cards
Chapter 4: Medicare Participating Providers
Why do medicare participating pro...,
By signing they agree to accept what,
What does medicare pays of the ap...
5
cards
Chapter 4: Medicare Non-Participating Providers
What are providers called who cho...,
Nonpars can still see medicare pa...,
Nonpars also must file all claims...
7
cards
Chapter 4: Advanced Beneficiary Notice (ABN)
The provider is permitted to bill...,
What is the abn,
A patient must be informed that t...
5
cards
Chapter 5: Network Coverage
What is managed care,
Keeping the cost of care as low a...,
Patients will pay less out of the...
6
cards
Chapter 5: Managed Care Activities: Utilization Review
Utilization review is a method of,
The benefits efficiency and medic...,
A prospective review assesses the...
8
cards
Chapter 5: Managed Care Activities: Quality Assurance
What does a quality assurance pro...,
What does types of quality review...,
Reviews conducted by independent ...
7
cards
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