Exam 17: Insurance and Billing

Who most frequently files insurance claims and handles insurers' payments for a medical practice?

To be covered under Medicare Part B, patients must ____.

A health plan provides ________, which are the payments for medical services provided to the patient.

A(n) "________" healthcare claim is one that is error-free and is accepted for processing by the payer.

One advantage of submitting claims electronically is ____.

The ________ payer is the health plan that pays for medical services.

The usual fees that are listed on the medical office's fee schedule are fees ____.

An insurance claims department compares the fee the doctor charges with the benefits provided by the patient's health plan. This is called the ____.

Using a clearinghouse to transmit electronic media claims ____.

The ________ charge is the maximum charge that the payer will pay a provider for a particular procedure or service.

An appropriate approach to maintaining patient confidentiality on the computer is to ____.

The payment system used by ________ is called the resource-based relative value scale (RBRVS).

In most cases, the insured person pays an annual cost or ____ for healthcare insurance.

When a physician agrees to accept assignment for a Medicare patient, this means the physician ____.

The person whose name the insurance is carried under is called the ____.

Insurers include either an explanation of payment or a(n) ________ advice along with payment to the practice or to the patient, depending on whether an assignment of benefits was signed.

Insurance carriers perform a review for medical ________ on each claim to determine whether the treatment is needed for the diagnosis listed.

An organization that provides pain relief to terminally ill patients and supports these patients and their families is a ____.

If your office submits paper claims, you should create and maintain a claims ________ to track the progress of submitted claims.

The ________ is the annual payment made to an insurance company by the patient to keep the insurance policy in effect.