NHA CCMA EXAM Review | 2023/ 2024 |
Highly Rated Guide Questions and 100% Verified Answers
QUESTION
Preferred provider organization (PPO)
Answer:
Managed care organization of providers, hospitals, and other healthcare providers who have
agreed with an insurer or a third party adminis...
Answer:
Managed care organization of providers, hospitals, and other healthcare providers who have
agreed with an insurer or a third party administrator to provide health care at a reduced rates to
the insurers administrators clients.
QUESTION
Medicaid provides healthcare coverage for whom?
Answer:
Provides health insurance for the medically needy.
QUESTION
Medicare is for?
Answer:
Federal insurance plan that generally covers those over the age of 65 and is considered an
entitlement because most have paid into the system through there employer.
QUESTION
Tricare is?
Answer:
Healthcare for military personal and their dependents to receive care form a civilian provider at
the expense of the federal government.
,QUESTION
What is the purpose of Workers Compensation?
Answer:
Wage replacement and medical benefits for those injured on the job.
QUESTION
Advance Beneficiary Notice (ABN)
Answer:
Waiver of liability, is a notice a provider should give you before you receive a service if, based
on Medicare coverage rules, your provider has reason to believe Medicare will not pay for the
service.
The bill will be the patients responsibility.
QUESTION
What is coinsurance?
Answer:
An amount a policy holder is responsible for according to their insurance policy.
The policy holder must meet a specific amount before the insurance company will pay their
portion.
QUESTION
What is a copay?
Answer:
A specific amount of money based on the patients insurance policy that must be paid at time of
service.
QUESTION
deductible?
Answer:
Specific amount of money a patient must pay out-of-pocket before the insurance carrier begins
paying for service in a calendar year.
,QUESTION
Explanation of benefits (EOB)?
Answer:
A statement detailing what services were paid, denied, or reduced in payment by the patients
insurance company.
QUESTION
Preauthorization?
Answer:
A decision by your health insurer or plan that that a health care service, treatment, plan,
perscription drug, or durable medical equipment is medically necessary.
QUESTION
Precertification?
Answer:
The process of obtaining eligibility, certification, or authorization and collecting information
from the health plan prior to impatient admissions and selected ambulatory care
QUESTION
Referral?
Answer:
The process of directing or redirecting to a medical specialist or agency for definitive treatment.
(Some insurance companies require this)
QUESTION
Verification of eligibility?
Answer:
Before care is provided, it is important to verify that a patients eligibility for service is active.
, QUESTION
CPT?
Answer:
Current Procedural Terminology
QUESTION
ICD?
Answer:
International classification of disease
Each diagnostic and procedural code allows for submission of services for reimbursement from
insurance companies and to provide statistical data for research.
QUESTION
There are how many characters used in ICD?
Answer:
Three to Seven
QUESTION
First character is used for what?
Answer:
Main term when searching in alphabetical order
QUESTION
Second and third characters?
Answer:
Numeric codes
QUESTION
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