NHA CCMA Exam 2022 – with accurate answers (verified)GradedA

Advance Beneficiary Notice (ABN) - Answers-A form provided to the patient when the provider believes Medicare will probably not pay for services received Allowed Amount - Answers-The maximum amount a third-party payer will pay for a particular procedure or service Copayment - Answers-a small fixed fee paid by the patient at the time of an office visit Coinsurance - Answers-a provision under which both the insured and the insurer share the covered losses, typically 80:20 deductible - Answers-specific amount of money a patient must pay out of pocket before the insurance carrier begins paying Explanation of Benefits - Answers-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) - Answers-Providers who agree to write off the difference between the amount charged by the provider and the approved fee established by the insurer Medicare - Answers-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 - Answers-U.S. government health insurance plan for all military personnel CHAMPVA - Answers-covers surviving spouses and dependent children of veterans who died as a result of service-related disabilities Medicaid - Answers-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 - Answers-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 - Answers-Standard insurance form used by all government and most commercial insurance payers. - 33 blocks - divided into three section CMS-1500 Section 1 - Answers-Carrier Block: contains the address of the insurance carrier and is located at the top of the form