Exam (elaborations)
Baycare EKG Test (solved) 2023/2024
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Baycare EKG Test (solved) 2023/2024
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Baycare EKG Test (solved) 2023/2024If PT WORKING AND SPOUSE RETIRED
insurance// medicare// insurance of retired spouse
WCOMP
takes priority over auto insurance ( do not bill auto)
PT INJURED ON CITY BUS OR PASSENGER.
1..auto or auto unknown? 2..insurance card
ONCE A TRICARE RECIPIENT PURCHASES MEDICARE A OR B THEIR TRICARE
BENEFITS BECOMES?
(tfl)tricare for life
"all military personnel are eligible for tricare"
false...if disabled not eligible or on active duty..
PREMIUM
amount paid monthly to a health plan provider in order to maintain health insurance
Deductible
fixed dollar amount the insured must pay before the health plan provider will begin to
cover any expenses
Copayment
fixed dollar the insured is required to pay each time they have a specified service
Coinsurance
fixed % the insured is required to pay each time they have specified service
Maximum out-of-pocket
total maximum amount the insured is required to pay before the health plan provider will
cover service at 100%
Out-of-pocket expense
any amount of money paid towards a service
provider
the person or entity providing health care related services ,
HDX
health data exchange
subscriber
person responsible for paying premiums
Guarantor
person financially responsible for the bill, usually the patient unless the patient is a
minor, in the case of minor t is the legal guardian who presents with the minor for
treatment.
medigap supplemental insurance
a plan offered by a private insurance carrier to supplement Medicare coverage
secondary health insurance
an additional health plan that pays benefits after the primary insurance payer
HRA health reimbursement account
employer funded medical reimbursement plans. the employer sets aside a specific
dollar amount that reimburses employees for out of pocket medical expenses
member/ enrollee
any person covered under health insurance
, HIPAA
healthcare insurance portability and accountability act
phi
protected health information
hie
health information exchange
EMTALA (Emergency Medical Treatment and Active Labor Act)
PPACA (Patient Protection and Affordable Care Act)
if self pay we need COB
medigap=supplement ..secondary to medicare
demographic overlay and identifier overlay differences
demographic- select wrong patient but changed DOB, address etc
identifier- selecting wrong patient but do not change any info
a BCBS COB form must be completed when patient has any type of bcbs
insurance? true/false?
true
tricare champva secondary
Medicare Part A Coverage
managed care plan. optional
eyeglasses, dental
CAU
central authorization unit...collect payments
an average of 52% of all monies due from patients will to bad debt or collections
if not collected at time of service. t/f?
true
workers comp carrier's do not need authorization.. true/false
false
inpatient claims are not eligible to be reimbursed by work comp
false
what comment code should be used for all auto registration?
autoquestdata
what plan pt in auto accident and refuse to provide auto insurance info
auto unknown
all military personnel are eligible for tricare
false. if disabled or active duty.. not they get champva
deductible for calendar year $?
1484
medicare is secondary payer for 30 mth coordination period for ESrd patients?
true
5 c's
collections, challenge, choose the right patient, confindentilty, customer service
3 issues that general consent forms cover
diagnostic radiology
RT lab testing
blood transfusions
minors on Medicaid always
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