MO136 Exam Study Questions with Verified
Correct Answers
Three part of an insurance contract
Patient, provider and payer/ insurance company
Fee for service
Patient receives the service and then the provider bills the payer (ins. Company)
Capitated rate
Fixed prepayment to a provider for medically necessary service
Out of pocket expenses
Expenses for Medicare that aren't reimbursed by the insurance company
Referral
Transfer of patient care from one physician to another.
Pre-authorization
requirement for some health insurance plans to obtain permission for a service or procedure
before it is done.
Medicare
A federal program of health insurance for persons 65 years of age and older
Tricare
U.S. government health insurance plan for all military personnel
Champva
Civilian Health and Medical Program of the Department of Veterans Affairs
Medicaid
A federal and state assistance program that pays for health care services for people who cannot
afford them.
, subpoena duces tecum
A legal document requiring the recipient to bring certain written records to court to be used as
evidence in a lawsuit
Standards for Documentation
Recording and organizing a patients medical record in a consistent manner
HIPPA Security Rule
Administrative, technical, and physical safeguards that are required to protect patients health
information
Electronic code sets
Group of code sets encoding data elements
Privacy rule
Requirement covers patients health information
Personal identifiers
Self-pay patient
patient with no insurance
Eligibility
the right of an individual to receive benefits under a specific plan
coordination of benefits
Explains how an insurance policy will pay if more than one policy applies
Eponym
a person whose name is, or is thought to be, the source of the name of something
HIPPA
Health Insurance Portability and Accountability Act of 1996
Health Maintenance Organization (HMO)
an organization that provides comprehensive medical care to subscribers for a fixed fee
Preferred Provider Organization (PPO)
Correct Answers
Three part of an insurance contract
Patient, provider and payer/ insurance company
Fee for service
Patient receives the service and then the provider bills the payer (ins. Company)
Capitated rate
Fixed prepayment to a provider for medically necessary service
Out of pocket expenses
Expenses for Medicare that aren't reimbursed by the insurance company
Referral
Transfer of patient care from one physician to another.
Pre-authorization
requirement for some health insurance plans to obtain permission for a service or procedure
before it is done.
Medicare
A federal program of health insurance for persons 65 years of age and older
Tricare
U.S. government health insurance plan for all military personnel
Champva
Civilian Health and Medical Program of the Department of Veterans Affairs
Medicaid
A federal and state assistance program that pays for health care services for people who cannot
afford them.
, subpoena duces tecum
A legal document requiring the recipient to bring certain written records to court to be used as
evidence in a lawsuit
Standards for Documentation
Recording and organizing a patients medical record in a consistent manner
HIPPA Security Rule
Administrative, technical, and physical safeguards that are required to protect patients health
information
Electronic code sets
Group of code sets encoding data elements
Privacy rule
Requirement covers patients health information
Personal identifiers
Self-pay patient
patient with no insurance
Eligibility
the right of an individual to receive benefits under a specific plan
coordination of benefits
Explains how an insurance policy will pay if more than one policy applies
Eponym
a person whose name is, or is thought to be, the source of the name of something
HIPPA
Health Insurance Portability and Accountability Act of 1996
Health Maintenance Organization (HMO)
an organization that provides comprehensive medical care to subscribers for a fixed fee
Preferred Provider Organization (PPO)
