chapter 7 medical office concepts Detailed Questions & Expert Answers
4 views 0 purchase
Course
Medical Office Concept
Institution
Medical Office Concept
accepting assignment - Correct Answer The agreement by a healthcare provider who participates in an insurance plan to accept the allowed charge as payment in full for services.
allowed charge - Correct Answer The maximum amount that an insurer will pay for a service or procedure; also called...
chapter 7 medical office concepts Detailed
Questions & Expert Answers
accepting assignment - Correct Answer The agreement by a healthcare provider who participates in an
insurance plan to accept the allowed charge as payment in full for services.
allowed charge - Correct Answer The maximum amount that an insurer will pay for a service or
procedure; also called "allowable," "maximum."
assignment of benefits - Correct Answer The permission given by a policyholder that allows a third-
party payer to pay benefits directly to the healthcare provider.
balance billing - Correct Answer Collecting payment from the insured patient of the difference between
a provider's usual fee and a payer's lower allowed charge.
birthday rule - Correct Answer A guideline for determining which of two parents with medical coverage
has the primary insurance for a child; states that the policy held by the insured with the earliest birthday
in the calendar year is the primary policy.
blue cross blue shield - Correct Answer One of the largest private-sector insurers in the United States;
offers both indemnity and managed care plans with many variations.
capitation - Correct Answer A form of payment made by the insurance company in advance of medical
services received; the prepayment by the insurance carrier of a fixed amount to a physician to cover ser
vices for a member of a particular plan.
carrier - Correct Answer An insurance company; also known as a third-party payer.
Centers for Medicare and Medicaid Services (CMS) - Correct Answer The federal agency responsible for
setting up the terms of Medicare and reviewing managed care plans that want to become Medicare-
covered providers; part of the Department of Health and Human Services, CMS was called the Health
Care Financing Administration (HCFA) before 2001.
, CHAMPVA - Correct Answer Acronym for the Civilian Health and Medical Program of the Veterans
Administration; the government health insurance program that covers the medical expenses of families
of veterans with total, permanent, service-connected disabilities; covers spouses and dependents of
veterans who die as a result of injuries sustained in the line of duty.
code linkage - Correct Answer The connection between the diagnostic and pro-cedural information,
examined by insurance carriers to evaluate the medical necessity of the reported charges.
coinsurance - Correct Answer The percentage of each claim that the insured person must pay; the
percentage to be paid by the carrier is usually stated first as in "a rate of 80-20."
coordination of benefits - Correct Answer The clause in insurance policies which states that the insured
who has two insurance policies may have only a maximum of 100 percent of the health costs.
copayment - Correct Answer The set charge, required by HMOs and some other insurers, to be paid by
patients every time they visit the physician's office.
cpt - Correct Answer The initials used for Current Procedural Terminology, a book published by the
American Medical Association and up-dated annually; contains the most commonly used system of
procedure codes.
customary fee - Correct Answer A physician's charge for a procedure or service determined by what
physicians with similar training and experi-ence in a certain geographic area typically charge.
deductible - Correct Answer A certain amount of medical expense the insured must incur before the
insurance carrier will begin paying benefits.
Defense Enrollment Eligibility Reporting System (DEERS) - Correct Answer The system used to list
individuals covered through TRICARE.
diagnosis related groups - Correct Answer A system used by Medicare to establish payment for hospital
stays; based on groupings of diagnostic codes that show the relative value of medical resources used
throughout the nation for patients with similar conditions.
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Victoria108. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $8.99. You're not tied to anything after your purchase.
