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

Working With Medical Insurance & Billing

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