Shared Flashcard Set

Details

Medical Billing 101 Chapter 2 Set 2
Health Insurance and the Identification Card
30
Medical
Professional
10/17/2010

Additional Medical Flashcards

 


 

Cards

Term
fee schedule
Definition
a list of allowed amounts for all services and procedures payable by the insurance company
Term
traditional, commercial
Definition
two terms that mean the same thing as an indemnity plan
Term
government plan
Definition
a health insurance plan funded by the government
Term
Centers for Medicare and Medicaid Services
Definition
What does CMS stand for?
Term
CMS
Definition
a government agency that oversees the Medicare and Medicaid programs
Term
Medicare
Definition
a government health insurance plan primarily covering persons aged 65 and older
Term
Medicaid
Definition
a government plan for financially indigent people
Term
outpatient
Definition
services performed at a facility where the patient stays less than 24 hours and is not admitted to the facility
Term
B
Definition
Physician and outpatient services are covered by Medicare part ____.
Term
beneficiary
Definition
a person who has Medicare coverage
Term
e
Definition

A person is eligible for Medicare if:

a) they are 65 years of age or older

b) they are disabled

c) they have end-stage renal disease

d) they have Medicare through spouse

e) all of the above

f) a and b

g) all but c

 

Term
False
Definition
T or F:  The rules of eligibility for Medicaid are national and not determined by the individual states.
Term
False
Definition

A patient's Medicare claim number is:

123-45-6789A.  When entering it on claims, you do not include the letter at the end--T or F?

Term
Original Medicare
Definition
the Medicare plan in which reimbursement for most services and procedures is paid at 80 percent of the allowed amount
Term
carrier
Definition
a company that has contracted with CMS to pay Part B claims
Term
indigent
Definition
impoverished; needy
Term
fiscal agent
Definition
a company that contracts with CMS to pay Medicaid claims
Term
eligibility category
Definition
a category listing requirements for a person to be covered by a specific plan
Term
managed care plan
Definition
a health insurance plan that includes financing, management, and delivery of health care services
Term
primary care provider
Definition
What does PCP stand for?
Term
PCP
Definition
a physician or other health care provider who is responsible for a patient's main health care
Term
specialist
Definition
a physician who specializes in a particular area of medicine
Term
prescription drugs
Definition
medications prescribed by a physician or other licensed prescriber
Term
emergency room visits
Definition
an encounter in the emergency room
Term
health maintenance organization
Definition
What does HMO stand for?
Term
HMO
Definition
a prepaid medical service plan that provides services to plan members
Term
in network
Definition
medical care sought from participating providers within a managed care plan
Term
out of network
Definition
medical care sought from nonparticipating providers; those providers who have not contracted with specific managed care plans
Term
preferred provider organization
Definition
What does PPO stand for?
Term
point-of-service plan
Definition
What does POS stand for?
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