Health Insurance Review

When a patient gives written authorization for reimbursement to the physician for billed charges, this is called:

• Coordination of benefits.

• Capitation

• Assignment of benefits.

• Copayment

Coordination of benefits means:

• The patient pays a specific amount ofmoney for medical services before the
  insurance pays.

• One insurance plan will work with
  other insurance plans to determine how
  much each plan pays.

• There is a flat fee paid for each ser-
  vice.

• There is a deductible required by the
  patient before payment from the insur-
  ance is made.

• Each insurance company will pay an
  equal amount of the patient's bill.

A medical administrative assistant is contacting the insurance payer to determine benefits coverage for a procedure and is requesting approval. Which of the following steps of the revenue cycle is being performed?

• Appeal

• Payer adjudication

• Eligibility and insurance preauthorization

• Encounter documentation

The person who is covered by a benefits plan is the:

• Employee

• Carrier

• Administrator

• Insured

A person's spouse or child who is covered under the benefits plan is called the:

• Group member.

• Coinsured

• Primary carrier

• Carrier

• Dependent

The amount that will be paid by the insurance plan for each procedure or service is based on the:

• Coinsurance

• Capitation

• Deductible

• Fee schedule

Government-sponsored insurance that provides health benefits to low-income or indigent

• CHAMPUS

• CHAMPVA

• Medicare

• Medicaid

• Blue Cross and Blue Shield

Expenses resulting from work-related illness or injury are usually covered by:

• Medicare

• HMO's

• Workers' compensation.

• Employee's health insurance

If a patient is diagnosed with a disease before the effective date of the insurance plan, it is a(n):

• Preexisting condition.

• Crossover claim

• Exclusion

• Capitation

The amount of eligible charges each patient must pay each calendar year before the plan begins to pay benefits is called:

• Coinsurance

• Exclusion

• Eligibility Capitation

• Deductible

• Capitation