NHA CCMA FINAL Exam .

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