chapter 7 medical office concepts exam questions and answers
accepting assignment - Answer -The agreement by a healthcare provider who participates in an insurance plan to accept the allowed charge as payment in full for services.
allowed charge - Answer -The maximum amount that an insurer will pay for a service or procedure; also called "allowable," "maximum."
assignment of benefits - Answer -The permission given by a policyholder that allows a third-party payer to pay benefits directly to the healthcare provider.
balance billing - Answer -Collecting payment from the insured patient of the difference between a provider's usual fee and a payer's lower allowed charge.
birthday rule - Answer -A guideline for determining which of two parents with medical coverage has the primary insurance for a child; states that the policy held by the insured
with the earliest birthday in the calendar year is the primary policy.
blue cross blue shield - Answer -One of the largest private-sector insurers in the United States; offers both indemnity and managed care plans with many variations.
capitation - Answer -A form of payment made by the insurance company in advance of medical services received; the prepayment by the insurance carrier of a fixed amount to
a physician to cover ser vices for a member of a particular plan.
carrier - Answer -An insurance company; also known as a third-party payer.
Centers for Medicare and Medicaid Services (CMS) - Answer -The federal agency responsible for setting up the terms of Medicare and reviewing managed care plans that
want to become Medicare-covered providers; part of the Department of Health and Human Services, CMS was called the Health Care Financing Administration (HCFA) before 2001.
CHAMPVA - Answer -Acronym for the Civilian Health and Medical Program of the Veterans Administration; the government health insurance program that covers the
accepting assignment - Answer -The agreement by a healthcare provider who participates in an insurance plan to accept the allowed charge as payment in full for services.
allowed charge - Answer -The maximum amount that an insurer will pay for a service or procedure; also called "allowable," "maximum."
assignment of benefits - Answer -The permission given by a policyholder that allows a third-party payer to pay benefits directly to the healthcare provider.
balance billing - Answer -Collecting payment from the insured patient of the difference between a provider's usual fee and a payer's lower allowed charge.
birthday rule - Answer -A guideline for determining which of two parents with medical coverage has the primary insurance for a child; states that the policy held by the insured
with the earliest birthday in the calendar year is the primary policy.
blue cross blue shield - Answer -One of the largest private-sector insurers in the United States; offers both indemnity and managed care plans with many variations.
capitation - Answer -A form of payment made by the insurance company in advance of medical services received; the prepayment by the insurance carrier of a fixed amount to
a physician to cover ser vices for a member of a particular plan.
carrier - Answer -An insurance company; also known as a third-party payer.
Centers for Medicare and Medicaid Services (CMS) - Answer -The federal agency responsible for setting up the terms of Medicare and reviewing managed care plans that
want to become Medicare-covered providers; part of the Department of Health and Human Services, CMS was called the Health Care Financing Administration (HCFA) before 2001.
CHAMPVA - Answer -Acronym for the Civilian Health and Medical Program of the Veterans Administration; the government health insurance program that covers the
