Exam 14: The Muscular System

Match each health insurance term with its definition. -Method of controlling health care costs by reviewing services to be provided to members of a plan to determine the appropriateness and medical necessity of the care prior to the delivery of the care

Match each health insurance term with its definition. -List of predetermined payment amounts for professional services provided to patients

Match each health insurance term with its definition. -Commercial plan in which the insurance company or group reimburses physicians or beneficiaries for services

In a(n) _____ plan, patients are able to see specialists without having to obtain referrals from another physician.

Health insurance offered by private companies to persons eligible for Medicare benefits and specifically designed to supplement such benefits is called:

Match each health insurance term with its definition. -Authorization, by signature, of a patient for payment to be paid directly to the physician for services

Match each health insurance term with its definition. -Health care delivery system that combines the delivery of health care and payment of the services

Part ___ of Medicare is for payment of medical expenses such as office visits and x-ray and laboratory services.

Which type of HMO is composed of providers who practice in their own individual offices and retain their own staff and operations?

Match each health insurance term with its definition. -Date when an insurance policy goes into effect

Match each health insurance term with its definition. -Required by Medicare when a service is provided to a beneficiary who is either not covered or the provider is unsure of coverage

Match each health insurance term with its definition. -Specified amount that the insured must pay toward the charge for professional services rendered at the time of service

A provider may not charge a patient for:

Match each health insurance term with its definition. -Insurance company that intervenes to pay hospital or medical bills per contract with the doctor or patient

The only practitioners that can currently bill Medicare with the hard copy CMS-1500s are businesses with:

Match each health insurance term with its definition. -Payments made to an insured person to help replace income lost through inability to work because of an insured disability

Physicians who treat patients under workers' compensation plans are usually required to register with the state Workers' Compensation Board:

The term ____ refers to the discovery of the maximum amount of money that a carrier will pay for primary surgery, consultation services, an so on.

Match each health insurance term with its definition. -Insurance offered to all employees by the employer

Match each health insurance term with its definition. -Government program that provides insurance coverage for those who are injured on the job or who have developed work-related disorders, disabilities, or illnesses