Vocabulary Health Care Plans Insurance in General Working in the Medical Insurance Field Mixture
What is a Schedule of benefits
What is a list of the medical services covered by an insurance policy
What is a fee for service payment made before or after services are provided?
Before patient visit
When is capitation payed?
Office manager
Who commonly heads administrative staff?
Collection process
If a patient payment is later than permitted under the financial policy of the practice what may be started
Electronic health record (EHR)
A computerized lifelong healthcare record for an individual that incorporates data from all sources that provide treatment for the individual
Managed Care
What are the two types of health care plans?
1. Clinics
2. Practices
3. Insurance Companies
4. Hospitals
5. Nursing Homes
Medical insurance specialists are employed mostly in what five places?
Pleasant tone, friendly attitude, helpful manner
What skills do effective communicators posses?
Percentage of a charge
Coinsurance is calculated based on:
Preferred provider organization (PPO)
What is a managed care network of providers under contract to provide services at discounted fees
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?
Combine financing and delivery of healthcare services.
What is the goal of a managed care plan?
The movement of monies into or out of a business
What does it mean to manage cash flow?
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?
What is a health plan that protects beneficiaries against losses
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.
1. Analyze charges and coverages
2. Process payments
3. Collect payments
Three main job functions of medical insurance specialists are:
Nearly 20; some with more than 80
How many health plans does the average practice work?
TRICARE, CHAMVA, Medicare, and Medicade
The major government sponsored health programs are:
What is the percentage of each claim that an insured person must pay
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?
Payments remain the same regardless of services rendered.
How are charges payed in the capitated rate payment system?
Systems that record, store and manage patient information
Name three types of health information technology.
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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