chapter 7 medical office concepts Exam Questions With Solutions 100% Correct

chapter 7 medical office concepts Exam Questions With Solutions 100% Correct accepting assignment 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 The maximum amount that an insurer will pay for a service or procedure; also called "allowable," "maximum." assignment of benefits The permission given by a policyholder that allows a third -party payer to pay benefits directly to the healthcare provider. balance billing Collecting payment from the insured patient of the difference between a provider's usual fee and a payer's lower allowed charge. birthday rule 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 One of the largest private -sector insurers in the United States; offers both indemnity and managed care plans with many variations. chapter 7 medical office concepts Exam Questions With Solutions 100% Correct capitation 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 An insurance company; also known as a third -party payer. Centers for Medicare and Medicaid Services (CMS) 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 Administrati on (HCFA) before 2001. CHAMPV A Acronym for the Civilian Health and Medical Program of the Veterans Administration; the government health insurance program that covers the medical expenses of families of veterans with total, permanent, service -connected disabilities; covers spouses and dependents of veterans who die as a result of injuries sustained in the line of duty. code linkage The connection between the diagnostic and pro -cedural information, examined by insurance carriers to evaluate the medical necessity of the reported charges.