Kinn's Medical Assistant 14th Edition- CH 15 All Possible Questions and Answers with complete solution
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Module
Kinn\'s Medical Assistant 14th Edition- CH 15
Institution
Kinn\'s Medical Assistant 14th Edition- CH 15
provider web portal - a secure online website that gives contracted providers a single point of
access to insurance companies this allows the provider to determine eligibility and deductible status,
submit preauthorizations/precertifications, and check the status of claims.
Explanation of Benefi...
Kinn's Medical Assistant 14th Edition-
CH 15
provider web portal - a secure online website that gives contracted providers a single point of
access to insurance companies this allows the provider to determine eligibility and deductible status,
submit preauthorizations/precertifications, and check the status of claims.
Explanation of Benefits (EOB) - A document sent by the insurance company to the provider and
the patient explaining the allowed charge amount, the amount reimbursed for services, and the patient's
financial responsibilities.
adjudicate - to settle or determine judicially
audit - a process completed before claims submission in which claims are examined for accuracy
and completeness
capitation - a payment arrangement for healthcare providers. The provider is payed a set amount
for each enrolled person assigned to them, per period of time, whether or not that person has received
services
claims clearinghouse - an organization that accepts the claim data from the provider, reformats
the data to meet the specifications outlined by the insurance plan, and submits the claim
claim scrubbers - software that finds common billing errors before the claim is sent to the
insurance company
CMS-1500 Health Insurance claim form - the standard insurance claim form used for all
government and most commercial insurance companies.
copayment (copay) - A set dollar amount that a patient must pay out-of-pocket for medication
when it's dispensed
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