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Medical Insurance billing test Flashcards

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13144229767StereotypeA generalized belief about a group of people0
13144232904Out of Pocket expenseSpecific amount of money that you pay when insurance only covers a portion of cost1
13144236704Encounter forma list of the procedures and charges for a patient's visit2
13144241022Electronic Claimalternative to paper claim, submitted to payer directly by physician or clearinghouse. Are usually paid faster. Most electronic claims software have self-editing features that detect and report entries that may cause to be rejected, such as invalid codes or incomplete claims3
13144241023Paper Claimtraditional method used by providers for submission of charges to ins co's. The most commonly used form is the CMS-1500. Few plans will still accept the physicians encounter forms or superbill and Medicare will only accept claims onthe CMS-15004
13144250232Reimbursementamount paid to patient toward the cost of healthcare services5
13144255470Verification of benefitsDetermination of whether patient is eligible for coverage of services6
13144258842managed care referrala referral from physician to seek treatment from another specialty provider7
13144276103preauthorizationPrior approval for treatment and procedures8
13144300397secondary insurancesecond payer on a claim9
13144304156EDIElectronic Data Interchange10
13144304157CMSCenters for Medicare and Medicaid Services, currently administers the medicare program11
13144312672CHAMPVACoverage for veterans with service related injuries12
13144320010WCWorkman's Comp, an insurance plan that provides coverage for those injured on the job13
13144331823TricareU.S. government health insurance plan for all military personnel14
13144340450Medicare Part ACovers hospital care15
13144340452Medicare Part BCovers physician services16
13144344177Medicare Part CManaged care option17
13144357965Medicare Part Dcoverage for medications18
13144364498Filing LimitsThe amount of time allowed to file a claim for payment19
13144375446Supporting Claim Documentationreports, or test results that can be used to back up why a test or procedure or office visit was requires, Lab results, X ray, chart note20
13144386911Clean claimhealth insurance claim form that has been completed correctly without any errors or omissions21

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