MN552 STUDY SHEET 2026 UPDATED
QUESTIONS AND SOLUTIONS
◉ Allowed Amount.
Answer: The maximum amount a third-party payer will pay for a
particular procedure or service
◉ Copayment.
Answer: a small fixed fee paid by the patient at the time of an office
visit
◉ Coinsurance.
Answer: a provision under which both the insured and the insurer
share the covered losses, typically 80:20
◉ deductible.
Answer: specific amount of money a patient must pay out of pocket
before the insurance carrier begins paying
◉ Explanation of Benefits.
Answer: a form created by the insurance company to explain what
charges were covered, denied, or need more documentation based
on the claims submitted by the physician's office
,◉ Participating provider (PAR).
Answer: Providers who agree to write off the difference between the
amount charged by the provider and the approved fee established by
the insurer
◉ Medicare.
Answer: A federal program of health insurance for persons 65 years
of age and older by Part A (hospitalization) or Part B (routine
medical office visits)
◉ Tricare.
Answer: U.S. government health insurance plan for all military
personnel
◉ CHAMPVA.
Answer: covers surviving spouses and dependent children of
veterans who died as a result of service-related disabilities
◉ Medicaid.
Answer: provides health insurance to the medically indigent
population through a cost-sharing program between federal and
state governments for those who meet specific eligibility criteria
,◉ Managed Care.
Answer: is an umbrella term for plans that provide health care in
return for preset scheduled payments and coordinated care through
a defined network of providers and hospitals
◉ CMS-1500 form.
Answer: Standard insurance form used by all government and most
commercial insurance payers.
- 33 blocks
- divided into three section
◉ CMS-1500 Section 1.
Answer: Carrier Block: contains the address of the insurance carrier
and is located at the top of the form
◉ CMS-1500 Section 2.
Answer: Patient/insured section: contains information about the
patient or insured; includes boxes 1-13
◉ CMS-1500 Section 3.
Answer: Physician/Supplier Section: contains information about the
physician or supplier: boxes 14-33
, ◉ Supine Position.
Answer:
◉ Dorsal Recumbent Position.
Answer:
◉ Sims' Position.
Answer:
◉ Knee-elbow position.
Answer:
◉ Fowler's Position.
Answer:
◉ Lithotomy Position.
Answer:
◉ Epidural Injection.
Answer: epidural space of the spine
◉ Intra-arterial Injection.
QUESTIONS AND SOLUTIONS
◉ Allowed Amount.
Answer: The maximum amount a third-party payer will pay for a
particular procedure or service
◉ Copayment.
Answer: a small fixed fee paid by the patient at the time of an office
visit
◉ Coinsurance.
Answer: a provision under which both the insured and the insurer
share the covered losses, typically 80:20
◉ deductible.
Answer: specific amount of money a patient must pay out of pocket
before the insurance carrier begins paying
◉ Explanation of Benefits.
Answer: a form created by the insurance company to explain what
charges were covered, denied, or need more documentation based
on the claims submitted by the physician's office
,◉ Participating provider (PAR).
Answer: Providers who agree to write off the difference between the
amount charged by the provider and the approved fee established by
the insurer
◉ Medicare.
Answer: A federal program of health insurance for persons 65 years
of age and older by Part A (hospitalization) or Part B (routine
medical office visits)
◉ Tricare.
Answer: U.S. government health insurance plan for all military
personnel
◉ CHAMPVA.
Answer: covers surviving spouses and dependent children of
veterans who died as a result of service-related disabilities
◉ Medicaid.
Answer: provides health insurance to the medically indigent
population through a cost-sharing program between federal and
state governments for those who meet specific eligibility criteria
,◉ Managed Care.
Answer: is an umbrella term for plans that provide health care in
return for preset scheduled payments and coordinated care through
a defined network of providers and hospitals
◉ CMS-1500 form.
Answer: Standard insurance form used by all government and most
commercial insurance payers.
- 33 blocks
- divided into three section
◉ CMS-1500 Section 1.
Answer: Carrier Block: contains the address of the insurance carrier
and is located at the top of the form
◉ CMS-1500 Section 2.
Answer: Patient/insured section: contains information about the
patient or insured; includes boxes 1-13
◉ CMS-1500 Section 3.
Answer: Physician/Supplier Section: contains information about the
physician or supplier: boxes 14-33
, ◉ Supine Position.
Answer:
◉ Dorsal Recumbent Position.
Answer:
◉ Sims' Position.
Answer:
◉ Knee-elbow position.
Answer:
◉ Fowler's Position.
Answer:
◉ Lithotomy Position.
Answer:
◉ Epidural Injection.
Answer: epidural space of the spine
◉ Intra-arterial Injection.
