Medical Insurance billing test Flashcards

13144229767	Stereotype	A generalized belief about a group of people	0
13144232904	Out of Pocket expense	Specific amount of money that you pay when insurance only covers a portion of cost	1
13144236704	Encounter form	a list of the procedures and charges for a patient's visit	2
13144241022	Electronic Claim	alternative 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 claims	3
13144241023	Paper Claim	traditional 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-1500	4
13144250232	Reimbursement	amount paid to patient toward the cost of healthcare services	5
13144255470	Verification of benefits	Determination of whether patient is eligible for coverage of services	6
13144258842	managed care referral	a referral from physician to seek treatment from another specialty provider	7
13144276103	preauthorization	Prior approval for treatment and procedures	8
13144300397	secondary insurance	second payer on a claim	9
13144304156	EDI	Electronic Data Interchange	10
13144304157	CMS	Centers for Medicare and Medicaid Services, currently administers the medicare program	11
13144312672	CHAMPVA	Coverage for veterans with service related injuries	12
13144320010	WC	Workman's Comp, an insurance plan that provides coverage for those injured on the job	13
13144331823	Tricare	U.S. government health insurance plan for all military personnel	14
13144340450	Medicare Part A	Covers hospital care	15
13144340452	Medicare Part B	Covers physician services	16
13144344177	Medicare Part C	Managed care option	17
13144357965	Medicare Part D	coverage for medications	18
13144364498	Filing Limits	The amount of time allowed to file a claim for payment	19
13144375446	Supporting Claim Documentation	reports, 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 note	20
13144386911	Clean claim	health insurance claim form that has been completed correctly without any errors or omissions	21