Medical Insurance

Which type of medical insurance plan requires each patient to choose a primary care provider (PCP) who belongs to network of covered providers, who arranges for specialist services or hospitalizations as needed by the patient

• HMO

• PPO

• EPO

• POS

The process to determine patient's eligibility

• VERIFICATION OF BENIFITS

• ELIGIBILITY

• DEPENDANTS

• PREMIUM

Patient is qualified to receive benefits under policy provisions.

• VERIFICATION OF BENIFITS

• ELIGIBILITY

• USUAL CHARGE

• ALLOWED AMOUNT

Family members covered under the policy.

• PREMIUM

• ALLOWED AMOUNT

• DEPENDANTS

• FEE SCHEDULE

The amount the policyholder pays to insurance carrier to purchase a commercial health insurance policy.

• FEE SCHEDULE

• PREMIUM

• ALLOWED AMOUNT

• USUAL CHARGE

Health care provider’s list of charges for each service they provide

• ELIGIBILITY

• USUAL CHARGE

• ALLOWED AMOUNT

• FEE SCHEDULE

The charge on provider’s fee schedule

• DEPENDANTS

• USUAL CHARGE

• ALLOWED AMOUNT

• PREMIUM

The amount that insurance companies consider to be appropriate fee

• PREMIUM

• FEE SCHEDULE

• ALLOWED AMOUNT

• USUAL CHARGE

Some of the MA responsibilities with Health Insurance Claims include all of the following except:

• Help gather information from patients

• Prepare health insurance claims accurately

• Collecting insurance premiums from the patient

• Follow up on past-due claims

Under_____________ Rule , a preexisting condition is covered without a waiting period when patient has been continuously insured for 24 months before joining the new plan

• HIPAA

• OSHA

• Medicare

• PPO