Medical Office Management - Final Exam Ch 16-20 Solved Correctly
To Sco A+
1. What was
To help individuals and families compensate for the high costs of medica
health care
insurance de-
signed for?
2. Exclusion The period of time between old insurance coverage and new insurance
cover-
age for a preexisting condition
3. Birthday Rule The plan of the parent whose birthday month comes first in the calenda
year
is primary.
4. In the birthday The month
rule, is the
month or the
year of the
birth date
used? Summarizes all of the benefits paid to the provider within a particular
period of time
5. Remittance
Advice (RA)
6. RA Remittance Advice
7. What is billed The ditterence between the provider's charges and the amount paid by
to the the insurance
patient?
8. Balance Billing The practice of billing patients for any balance left after deductibles,
coinsur-
ance, and insurance payments have been made
9. Preauthorization Prior approval for treatment and procedures from the insurance company
1/
37
, Medical Office Management - Final Exam Ch 16-20 Solved Correctly
To Sco A+
10. CMS-1500 Form used to submit Medicare claims; previously called the HCFA-1500.
11. Assignment authorization by policyholder that allows a health plan to pay benefits
of benefits directly to a provider
2/
37
, Medical Office Management - Final Exam Ch 16-20 Solved Correctly
To Sco A+
12. BCBS Blue Cross Blue Shield
13. BCBS The largest payer groups in the U.S.
14. PAR participating provider
15. What does a Chooses to sign a member contract and receives and incentive. PARs
par- ticipating agree to accept the BCBS reimbursement as payment in full for covere
provider of services.
BCBS need to
do?
16. What is Original Medicare
anoth- er
name for
Medicare?
17. Medicare Established in 1966; largest medical insurance program in the U.S.
18. Medicare Part A Pays for hospitalization, care in a skilled nursing facility, home health ca
and
hospice care.
19. Medicare Part B Pays for physician services, outpatient hospital services, durable medical
equip-
ment, and other services and supplies.
20. Medicare Part C managed care health plans ottered to medicare beneficiaries under the
medicare advantage program
21. Medicare Part D Prescription drug reimbursement plans
22. UCR usual, customary, and reasonable
23. Usual, customary, and reasonable (UCR) Fee
3/
37
, Medical Office Management - Final Exam Ch 16-20 Solved Correctly
To Sco A+
Sched- ule fee system that defines allowable charges that will be accepted by
insurance carriers.
4/
37
To Sco A+
1. What was
To help individuals and families compensate for the high costs of medica
health care
insurance de-
signed for?
2. Exclusion The period of time between old insurance coverage and new insurance
cover-
age for a preexisting condition
3. Birthday Rule The plan of the parent whose birthday month comes first in the calenda
year
is primary.
4. In the birthday The month
rule, is the
month or the
year of the
birth date
used? Summarizes all of the benefits paid to the provider within a particular
period of time
5. Remittance
Advice (RA)
6. RA Remittance Advice
7. What is billed The ditterence between the provider's charges and the amount paid by
to the the insurance
patient?
8. Balance Billing The practice of billing patients for any balance left after deductibles,
coinsur-
ance, and insurance payments have been made
9. Preauthorization Prior approval for treatment and procedures from the insurance company
1/
37
, Medical Office Management - Final Exam Ch 16-20 Solved Correctly
To Sco A+
10. CMS-1500 Form used to submit Medicare claims; previously called the HCFA-1500.
11. Assignment authorization by policyholder that allows a health plan to pay benefits
of benefits directly to a provider
2/
37
, Medical Office Management - Final Exam Ch 16-20 Solved Correctly
To Sco A+
12. BCBS Blue Cross Blue Shield
13. BCBS The largest payer groups in the U.S.
14. PAR participating provider
15. What does a Chooses to sign a member contract and receives and incentive. PARs
par- ticipating agree to accept the BCBS reimbursement as payment in full for covere
provider of services.
BCBS need to
do?
16. What is Original Medicare
anoth- er
name for
Medicare?
17. Medicare Established in 1966; largest medical insurance program in the U.S.
18. Medicare Part A Pays for hospitalization, care in a skilled nursing facility, home health ca
and
hospice care.
19. Medicare Part B Pays for physician services, outpatient hospital services, durable medical
equip-
ment, and other services and supplies.
20. Medicare Part C managed care health plans ottered to medicare beneficiaries under the
medicare advantage program
21. Medicare Part D Prescription drug reimbursement plans
22. UCR usual, customary, and reasonable
23. Usual, customary, and reasonable (UCR) Fee
3/
37
, Medical Office Management - Final Exam Ch 16-20 Solved Correctly
To Sco A+
Sched- ule fee system that defines allowable charges that will be accepted by
insurance carriers.
4/
37
