Chapter 9 Insurance (MA)

Also, known as a superbill, an itemized form of services submitted to insurance companies for reimbursement.

• Preauthorization

• An encounter form

• Insurance

• Patient Record

An amount paid, usually monthly, to keep a healthcare policy current.

• Co-payment

• Co-insurance

• Premium

• deductible

An insurance payment structure in which the insured pays a share of the payment made against a claim, always written as a fraction for which the insurer pays the top number and the patient pays the bottom number, e.g. 80/20.

• Co-payment

• Coinsurance

• Deductible

• Premium

A medical assistant in a specialty office is scheduling an appointment for a patient who has HMO insurance. What should the assistant obtain prior to seeing the patient?

• Referral

• Premium

• Coinsurance

• Patient Rights'

Prior approval for treatment and procedures is called:

• Approval

• New patient

• Implied Consent

• Preauthorization

A specified amount of money that the insured must pay before an insurance company will pay a claim:

• Premium

• Deductible

• EOB

• Release of payment

A statement detailing which services were paid, denied, or reduced by the patient's insurance company:

• NKDA

• STAT

• ADLs

• EOB

This Federal health insurance program provides, insurance for those aged 65 or older, certain people with disabilities, and those with ESRD.

• Medicaid

• Tri-health

• Medicare

• BCBS

This process confirms how a patient or their insurance provider will pay for services:

• Verification of Eligibility

• Preauthorization

• Verification of benefits

• Advance Directive

Wage replacement and medical benefits for those injured on the job is:

• Medicare

• Medicaid

• Benefits

• Workers' compensation