MAP 205 final exam 2
What is precertification? - Answer-The process to establish medical necessity before a treatment is
approved by the insurance company
What is utilization review used for? - Answer-examine healthcare services provided to patients for the
purpose of controlling costs
When a patient is injured on the job, who pays the doctors visits? - Answer-Workers Compensation
premiums are paid by the employer
How do Doctors get paid by the insurance company? - Answer-An assignment of benefits form must be
signed by the patient and kept on file
What is a beneficiary? - Answer-Employee's and dependants who join a managed care plan
What is an assignment of benefits form? - Answer-Allows the doctor's office to be paid by the insurance
company directly
How does the MA prevent a patient from receiving benefits from two insurances? - Answer-MA's must
adhere to the insurance filing order (Coordination of Benefits) rules when
a patient is covered by more than one insurance
What is an insurance carrier? - Answer-A company that sells and provides insurance
Who qualifies for Medicare? - Answer-Persons 65 years or older, people with permanent kidney failure,
person who has been on some social security program for at least 24 months
What is precertification? - Answer-The process to establish medical necessity before a treatment is
approved by the insurance company
What is utilization review used for? - Answer-examine healthcare services provided to patients for the
purpose of controlling costs
When a patient is injured on the job, who pays the doctors visits? - Answer-Workers Compensation
premiums are paid by the employer
How do Doctors get paid by the insurance company? - Answer-An assignment of benefits form must be
signed by the patient and kept on file
What is a beneficiary? - Answer-Employee's and dependants who join a managed care plan
What is an assignment of benefits form? - Answer-Allows the doctor's office to be paid by the insurance
company directly
How does the MA prevent a patient from receiving benefits from two insurances? - Answer-MA's must
adhere to the insurance filing order (Coordination of Benefits) rules when
a patient is covered by more than one insurance
What is an insurance carrier? - Answer-A company that sells and provides insurance
Who qualifies for Medicare? - Answer-Persons 65 years or older, people with permanent kidney failure,
person who has been on some social security program for at least 24 months
