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