Mod H Unit 1 Study Guide
Mod H Unit 1 Study Guide
A type of HMO whereby services are provided by outpatient networks composed of individual health care providers who supply all necessary patient care is a(n):
The four basic types of health insurance fall into two broad categories, which are:
Many FFS policies set a limit for what they will reimburse their members for any charges incurred, which is referred to as a(n):
PAR providers contracting with Blue Cross Blue Shield must file claims within 365 days following the last date of service provided to the patient. This is referred to as:
The private, not-for-profit organization dedicated to improving health care quality and frequently referred to as the managed care “watch dog” is:
Many self-insured groups hire a specific type of organization to manage and pay claims called:
Policy premiums, yearly deductible, and coinsurance are the three out-of-pocket costs in:
A health care provider trained in a specific medical specialty is a:
A private, nonprofit organization that accredits health care plan based on evaluation of the quality of care given to plan members is the:
A request by a health care provider for his or her patient to be evaluated or treated by a specialist is a:
When the employer – not an insurance company – is responsible for the cost of medical services, it is referred to as:
When a patient is sent to another provider (often a specialist) with the intent of rendering an expert opinion on a specific health complaint, it is called a:
With many MCOs, the enrollee typically pays a small fee upfront when visiting his or her PCP called a(n):
Many Americans obtain health insurance owing to their employment through what is commonly referred to as:
What are the plan types within managed care plans?
The formal term fir a written complaint submitted by an individual covered a special plan or policy is called a:
To reduce unnecessary inpatient/outpatient services, managed care plan use:
Today, the “Blue System” is the largest single processor of Medicare claims, which is called a:
Individuals who are members of a managed care plan are commonly referred to as:
A group of health care providers working under one umbrella to provide medical services at a discount to the individuals who participate in the plan is referred to as a(n):
A document prepared by the carrier that gives details to how claim was adjudicated is called a(n):
A specific provider who oversees the entire care and treatment of a patient in an HMO is called a:
A system designed to determine the medical necessity and appropriateness of a requested medical service or procedure is a(n):
A multispecialty practice in which health care services are provided within the building complex owned by the health maintenance organization (HMO) is referred to as a(n):
Members of a PPO normally do not have to choose a:
Which organizations are responsible for creating the revised CMS-1500 (08-05)?
The front side of the CMS-1500 is printed in:
Patient information is entered in:
The most common format used for computer text files and on the Internet is:
OCR works best with original copies using:
What are the specific guidelines for OCR scannableclaims:
Medicare claims must be submitted electronically, unless the HHS Secretary grants a(n):
What documents needed to complete a paper CMS-1500:
The document on which patient’s charges and payments are recorded is the:
What is the correct reporting of birth date in block 3 of the CMS-1500?
Submitting insurance claims directly to a third-party payer is called:
A claim that has no errors, omissions and can be processed without delays is called:
The main reason for revising the CMS-1500 form is for:
The 9-digit federal tax identification number is commonly referred to as the:
The bottom half of the CMS-1500 form is used for:
The two main section of the CMS-1500 are:
One of the health insurance professional’s most important responsibilities is:
The source for patient information, such as name of insurer, policy number, copayment and/or name of primary care physician, can be found on:
A medical record should:
A preprinted form customized to the practice’s specialty, listing procedures and diagnoses common to the practice as well as codes and fees is the:
What blocks is the patient/insured section of the CMS-1500?
A common cause for insurance claims to be rejected is:
Identify an important advantage of filing claims electronically:
The primary objective in submitting claims is to:
Under what circumstances is a claim attachment necessary?
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