©THEBRIGHT EXAM STUDY SOLUTIONS 8/27/2024 12:01 PM
Kinn's Medical Assistant 14th Edition- CH
15 . Exams Questions With Correct
Answers.
Adjudicate - answer✔✔to settle or determine judicially
audit - answer✔✔a process completed before claims submission in which claims are examined
for accuracy and completeness
capitation - answer✔✔a payment arrangement for healthcare providers. The provider is payed a
set amount for each enrolled person assigned to them, per period of time, whether or not that
person has received services
claims clearinghouse - answer✔✔an organization that accepts the claim data from the provider,
reformats the data to meet the specifications outlined by the insurance plan, and submits the
claim
claim scrubbers - answer✔✔software that finds common billing errors before the claim is sent to
the insurance company
CMS-1500 Health Insurance claim form - answer✔✔the standard insurance claim form used for
all government and most commercial insurance companies.
copayment (copay) - answer✔✔A set dollar amount that a patient must pay out-of-pocket for
medication when it's dispensed
eligibility - answer✔✔meeting the stipulated requirements, as to participate, compete, or work;
qualified
endoscopy - answer✔✔nonsurgical procedure used to examine a person's digestive tract
Explanation of Benefits (EOB) - answer✔✔A document sent by the insurance company to the
provider and the patient explaining the allowed charge amount, the amount reimbursed for
services, and the patient's financial responsibilities.
medical necessity - answer✔✔Services or supplies must be appropriate and necessary for the
symptoms, diagnosis, and/or treatment of the medical condition and they meet the standards of
good medical practice
Kinn's Medical Assistant 14th Edition- CH
15 . Exams Questions With Correct
Answers.
Adjudicate - answer✔✔to settle or determine judicially
audit - answer✔✔a process completed before claims submission in which claims are examined
for accuracy and completeness
capitation - answer✔✔a payment arrangement for healthcare providers. The provider is payed a
set amount for each enrolled person assigned to them, per period of time, whether or not that
person has received services
claims clearinghouse - answer✔✔an organization that accepts the claim data from the provider,
reformats the data to meet the specifications outlined by the insurance plan, and submits the
claim
claim scrubbers - answer✔✔software that finds common billing errors before the claim is sent to
the insurance company
CMS-1500 Health Insurance claim form - answer✔✔the standard insurance claim form used for
all government and most commercial insurance companies.
copayment (copay) - answer✔✔A set dollar amount that a patient must pay out-of-pocket for
medication when it's dispensed
eligibility - answer✔✔meeting the stipulated requirements, as to participate, compete, or work;
qualified
endoscopy - answer✔✔nonsurgical procedure used to examine a person's digestive tract
Explanation of Benefits (EOB) - answer✔✔A document sent by the insurance company to the
provider and the patient explaining the allowed charge amount, the amount reimbursed for
services, and the patient's financial responsibilities.
medical necessity - answer✔✔Services or supplies must be appropriate and necessary for the
symptoms, diagnosis, and/or treatment of the medical condition and they meet the standards of
good medical practice
