NHA CCMA Exam Study Questions and Answers

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