Chapt 9 Medical Insurance and Coding

A summary of coverage provided to a patient and a health insurance company after a claim is made is called a(n) _______.

• Explanation of Benefits

• IHS

• Claim Report

• Coverage Statement

_______ are those services essential to the patient's health and well-being.

• Medically necessary services

• Optional services

• Recreational services

• Non-essential services

If the provider is part of an insurer's network, the insurer's allowable amount must be _______.

• Paid by the Patient

• Higher than the billed amount

• Paid by the insurance company

• Negotiated between provider and insurer

Describe government-funded insurance programs. In addition to covering people 65 and older, Medicare covers:

• People with low income

• People who live in certain states or territories

• All military veterans

• People with end-stage kidney disease

Medicaid is administered and operated:

• By the state level

• At the federal level

• By Medicare Administrative Contractors

• At the county level

Which of the following is true about the Indian Health Service?

• It is an insurance program for American Indians and Alaskan Natives.

• It provides healthcare options through tribal and urban Indian health programs for free.

• It is a federal program available to all US citizens.

• It is a private health service.

Which program provides low-cost health coverage to families with children who earn too much to qualify for Medicaid?

• NHS

• CHIP

• CHAMPVA

• TRICARE

Explain coordination of benefits. When a patient is covered by more than one insurance policy, one policy is considered the ________, and the other is the ________.

• primary; secondary

• first; second

• major; minor

• main; supplementary

Which of these health insurance programs is available to active duty and retired members of the military and their families?

• Medicare

• CHIP

• TRICARE

• Medicaid

When a provider’s office sends claims electronically, they are usually paid faster than when claims are sent by paper.

• True

• False