NHA CBCS Module 2 Insurance Eligibility
and Other Payer Requirements Questions
With Correct Answers
capitation - CORRECT ANSWER✔✔-An agreement with a provider to
| | | | | | | | |
receive a pre-established payment for health care services to enrollees
| | | | | | | | | |
over a period of time.
| | | |
coinsurance - CORRECT ANSWER✔✔-Predetermined percentage the
| | | | | |
patient is responsible to pay for covered services once the annual
| | | | | | | | | | |
deductible has been met. | | |
copayment (copay) - CORRECT ANSWER✔✔-Flat, fixed amount that a
| | | | | | | | |
patient pays for specific services (e.g., office or emergency department
| | | | | | | | | |
encounters).
covered benefits - CORRECT ANSWER✔✔-Services outlined in the policy
| | | | | | | | |
that are payable by the health plan.
| | | | | |
deductible - CORRECT ANSWER✔✔-Annual amount the patient must pay
| | | | | | | | |
before the insurance will begin to pay for covered benefits.
| | | | | | | | |
,guarantor - CORRECT ANSWER✔✔-The individual who is responsible for
| | | | | | | | |
paying any patient responsibility after the insurance has processed a
| | | | | | | | | |
claim.
health maintenance organization (HMO) - CORRECT ANSWER✔✔-A
| | | | | | |
group of contracted providers that agree to the payment contract for its
| | | | | | | | | | | |
members.
in-network (INN) - CORRECT ANSWER✔✔-A provider who has signed an
| | | | | | | | | |
agreement with the insurance plan.
| | | |
noncovered services - CORRECT ANSWER✔✔-Services that are not
| | | | | | | |
payable by the health plan.
| | | |
out-of-network (OON) - CORRECT ANSWER✔✔-A provider who does not
| | | | | | | | |
have a signed agreement with an insurance plan.
| | | | | | |
policyholder - CORRECT ANSWER✔✔-The individual who signs a contact
| | | | | | | | |
with a health insurance company.
| | | |
preferred provider organization (PPO) - CORRECT ANSWER✔✔-a type of
| | | | | | | | |
managed care organization where providers join the network and are
| | | | | | | | | |
considered preferred when a patient seeks treatment.
| | | | | |
, premium - CORRECT ANSWER✔✔-The amount a patient pays each
| | | | | | | | |
month to receive benefits.
| | |
electronic medical record (EMR) - CORRECT ANSWER✔✔-A patient's
| | | | | | | |
medical record in a digital format that resides within a health care
| | | | | | | | | | | |
organization.
electronic health record (EHR) - CORRECT ANSWER✔✔-a collective of
| | | | | | | | |
medical records that is used and shared by more than one organization or
| | | | | | | | | | | | |
provider.
workers' compensation - CORRECT ANSWER✔✔-Provides benefits and
| | | | | | |
wages replacements to employees who need medical care due to a work-
| | | | | | | | | | |
related injury. |
automobile insurance - CORRECT ANSWER✔✔-Protects the diver and
| | | | | | | |
passengers and pays for medical expenses and other expenses (wage
| | | | | | | | | |
replacement, rental vehicles) related to an accident.
| | | | | |
National Association of Insurance Commissioners (NAIC) - CORRECT
| | | | | | | |
ANSWER✔✔-Identifies the coverage requirements for auto insurance. | | | | | | |
Each state develops their own laws as long as the minimum standards are
| | | | | | | | | | | | |
met.
and Other Payer Requirements Questions
With Correct Answers
capitation - CORRECT ANSWER✔✔-An agreement with a provider to
| | | | | | | | |
receive a pre-established payment for health care services to enrollees
| | | | | | | | | |
over a period of time.
| | | |
coinsurance - CORRECT ANSWER✔✔-Predetermined percentage the
| | | | | |
patient is responsible to pay for covered services once the annual
| | | | | | | | | | |
deductible has been met. | | |
copayment (copay) - CORRECT ANSWER✔✔-Flat, fixed amount that a
| | | | | | | | |
patient pays for specific services (e.g., office or emergency department
| | | | | | | | | |
encounters).
covered benefits - CORRECT ANSWER✔✔-Services outlined in the policy
| | | | | | | | |
that are payable by the health plan.
| | | | | |
deductible - CORRECT ANSWER✔✔-Annual amount the patient must pay
| | | | | | | | |
before the insurance will begin to pay for covered benefits.
| | | | | | | | |
,guarantor - CORRECT ANSWER✔✔-The individual who is responsible for
| | | | | | | | |
paying any patient responsibility after the insurance has processed a
| | | | | | | | | |
claim.
health maintenance organization (HMO) - CORRECT ANSWER✔✔-A
| | | | | | |
group of contracted providers that agree to the payment contract for its
| | | | | | | | | | | |
members.
in-network (INN) - CORRECT ANSWER✔✔-A provider who has signed an
| | | | | | | | | |
agreement with the insurance plan.
| | | |
noncovered services - CORRECT ANSWER✔✔-Services that are not
| | | | | | | |
payable by the health plan.
| | | |
out-of-network (OON) - CORRECT ANSWER✔✔-A provider who does not
| | | | | | | | |
have a signed agreement with an insurance plan.
| | | | | | |
policyholder - CORRECT ANSWER✔✔-The individual who signs a contact
| | | | | | | | |
with a health insurance company.
| | | |
preferred provider organization (PPO) - CORRECT ANSWER✔✔-a type of
| | | | | | | | |
managed care organization where providers join the network and are
| | | | | | | | | |
considered preferred when a patient seeks treatment.
| | | | | |
, premium - CORRECT ANSWER✔✔-The amount a patient pays each
| | | | | | | | |
month to receive benefits.
| | |
electronic medical record (EMR) - CORRECT ANSWER✔✔-A patient's
| | | | | | | |
medical record in a digital format that resides within a health care
| | | | | | | | | | | |
organization.
electronic health record (EHR) - CORRECT ANSWER✔✔-a collective of
| | | | | | | | |
medical records that is used and shared by more than one organization or
| | | | | | | | | | | | |
provider.
workers' compensation - CORRECT ANSWER✔✔-Provides benefits and
| | | | | | |
wages replacements to employees who need medical care due to a work-
| | | | | | | | | | |
related injury. |
automobile insurance - CORRECT ANSWER✔✔-Protects the diver and
| | | | | | | |
passengers and pays for medical expenses and other expenses (wage
| | | | | | | | | |
replacement, rental vehicles) related to an accident.
| | | | | |
National Association of Insurance Commissioners (NAIC) - CORRECT
| | | | | | | |
ANSWER✔✔-Identifies the coverage requirements for auto insurance. | | | | | | |
Each state develops their own laws as long as the minimum standards are
| | | | | | | | | | | | |
met.
