EXAM: Chapter 15Kinn's Medical Assistant 14th EditionQuestions and Answers 100% Solved
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Course
Kinns
Institution
Kinns
EXAM: Chapter 15Kinn's Medical Assistant 14th EditionQuestions and Answers 100% Solved
adjudicate CORRECT ANS-to settle or determine judicially
audit CORRECT ANS-a process completed before claims submission in which claims are
examined for accuracy and completeness
EXAM: Chapter 15 Kinn's Medical Assistant 14th Edition-
Questions and Answers 100% Solved
adjudicate CORRECT ANS-to settle or determine judicially
audit CORRECT ANS-a process completed before claims submission in which claims are
examined for accuracy and completeness
capitation CORRECT ANS-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 CORRECT ANS-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 CORRECT ANS-software that finds common billing errors before the claim
is sent to the insurance company
CMS-1500 Health Insurance claim form CORRECT ANS-the standard insurance claim form
used for all government and most commercial insurance companies.
, EXAM: Chapter 15 Kinn's Medical Assistant 14th Edition-
Questions and Answers 100% Solved
copayment (copay) CORRECT ANS-A set dollar amount that a patient must pay out-of-
pocket for medication when it's dispensed
eligibility CORRECT ANS-meeting the stipulated requirements, as to participate, compete,
or work; qualified
endoscopy CORRECT ANS-nonsurgical procedure used to examine a person's digestive tract
Explanation of Benefits (EOB) CORRECT ANS-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.
medical necessity CORRECT ANS-Services or supplies must be appropriate and necessary
for the symptoms, diagnosis, and/or treatment of the medical condition and they meet the
standards of good medical practice
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