Ch 1 Working With Medical Insurance Billing Jeopardy Template

Vocabulary	Health Care Plans	Insurance in General	Working in the Medical Insurance Field	Mixture
200 What is a Schedule of benefits What is a list of the medical services covered by an insurance policy	200 After What is a fee for service payment made before or after services are provided?	200 Before patient visit When is capitation payed?	200 Office manager Who commonly heads administrative staff?	200 Collection process If a patient payment is later than permitted under the financial policy of the practice what may be started
400 Electronic health record (EHR) A computerized lifelong healthcare record for an individual that incorporates data from all sources that provide treatment for the individual	400 Indemnity Managed Care What are the two types of health care plans?	400 1. Clinics 2. Practices 3. Insurance Companies 4. Hospitals 5. Nursing Homes Medical insurance specialists are employed mostly in what five places?	400 Pleasant tone, friendly attitude, helpful manner What skills do effective communicators posses?	400 Percentage of a charge Coinsurance is calculated based on:
600 Preferred provider organization (PPO) What is a managed care network of providers under contract to provide services at discounted fees	600 1. Medically necessary 2. Premium 3. Deductible 4. Coinsurance What four conditions must be met before the insurance company makes a payment for an indemnity claim?	600 Combine financing and delivery of healthcare services. What is the goal of a managed care plan?	600 The movement of monies into or out of a business What does it mean to manage cash flow?	600 After the encounter and after the payers payment is posted When a patient has insurance coverage for which the practice will create a claim, the patients bill is due when?
800 Indemnity What is a health plan that protects beneficiaries against losses	800 1. health maintenance organization 2. point of service plan 3. preferred provider organization 4. consumer driven health plans List the four basic types of managed care plans.	800 1. Analyze charges and coverages 2. Process payments 3. Collect payments Three main job functions of medical insurance specialists are:	800 Nearly 20; some with more than 80 How many health plans does the average practice work?	800 TRICARE, CHAMVA, Medicare, and Medicade The major government sponsored health programs are:
1000 Coinsurance What is the percentage of each claim that an insured person must pay	1000 1. Restricting patients choice 2. Requiring pre-authorization for services 3. Controlling the use of services 4. Controlling drug costs 5. Cost sharing What five methods does an HMO use to contain cost?	1000 Payments remain the same regardless of services rendered. How are charges payed in the capitated rate payment system?	1000 Systems that record, store and manage patient information Name three types of health information technology.	1000 Consumer driven health plan (CDHP) Which of the following combines a health plan that has a high deductible and low premiums with a special savings account that is used to pay medical bills before the deducible has been met?

Ch. 1: Working With Medical Insurance & Billing

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