Understanding Health Insurance Full Solution Pack; Bundled Exams 2023 with complete solution

Health Insurance Claim - The documentation submitted to a third-party payer or government program requesting reimbursement for health care services provided. Preauthorization - Prior approval for treatment. What is a hold harmless clause? - The patient is not responsible for paying what the insur...

Calculate the following amounts for a participating provider who bills Medicare: Submitted charge (based on provider's regular fee for office visit)$ 75 Medicare physician fee schedule (PFS)$ 60 Coinsurance amount (paid by patient or supplemental insurance)$ 12 Medicare payment (80 percent of t...

Physician submit _____ service/procedure codes to payers. 1) ICD-10-CM 2) HCPCS level III 3) DSM-5 4) CPT/HCPCS level II - CPT/HCPCS level II The reverse of the CMS-1500 claim contains special instructions for 1) BlueCross and BlueShield. 2) Private commercial insurance. 3) Government progra...

Which means that the patient and/or insured has authorized the payer to reimburse the provider directly? 1) Assignment of benefits 2) Medical necessity 3) Coordination of benefits 4) Accept assignment - Assignment of benefits Providers who do not accept assignment of Medicare benefits do not r...

One of the requirements that a participating provider must comply with is to 1) Make fee adjustments for the difference between amounts charged to patients for services provided and payer-approved fees. 2) Write off deductible and copay/coinsurance amounts and accept as payment in full the BCBS-a...

When a patient is covered by a large employer group health plan (EGHP) and Medicare, which is primary? 1) Medicare 2) The plan that has been in place longest 3) No distinction is made between the plans 4) EGHP - EGHP When a child who is covered by two or more plans lives with his married paren...

Managed Health Care - Combines health care delivery with the financing of services provided. Consumer-directed Health Plans (CDHP) - Provide incentives for controlling healthcare expenses and give individuals an alternative to traditional health insurance and managed care coverage. (Define employ...

The document submitted to the payer requesting reimbursement is called a - health insurance claim The Centers for Medicare and Medicaid Services (CMS) is an administration within the - Department of Health and Human Services A healthcare practioner is also called a - provider Which is the most a...

The documentation submitted to the payer requesting reimbursement is called a(n) - A. Explanation of benefits The Centers for Medicare and Medicaid Services CMS is an administration within the - B. Department of Health and Human Services (DHHS) A health care practitioner is also called a health ...

Reimbursement specialist - Health insurance specialist Hold Harmless Clause - Patient is not responsible for paying what the insurance plan denies No Balance Billing Clause - Clause that protects patients from being billed for amounts not reimbursed by payers Centers for Medicare and Medicaid Se...