HCA 110 Insurance, Billing and Codding Questions with Correct Solutions

Coinsurance - A fixed percentage of covered charges paid by the insured person after the deductible has been met Fee Schedule - A list of charges for services or procedures performed A managed care program in which its members are expected to receive treatment only from one of its participating providers - HMO A provider who participates in an insurance carrier's plan is considered to be - PAR An explanation of benefits (EOB) is called - RA Assignment of benefit statements are completed with these types of providers to ensure payment directly from the insurer to the provider - PAR Coordination of benefits refer to - the legality of having more than one insurance policy Elderly or disabled patients who qualify for Medicare and who cannot pay for Medicare's charges may qualify for dual coverage also know as - Medi/Medi Electronic claims can be sent directly to an insurance plan or through a _______ where the claim information will be standardized and "scrubbed". - Clearinghouse If a claim is submitted electronically, the remittance advice, how is the claim received? - Electronically Medicare Part A pays what portion of hospitalization for the first 60 days - 100% Medicare is divided into two main parts - A and B Medicare part A covers hospital benefits, while part _____ covers outpatient - B Medicare part B has a patient coinsurance responsibility of what percentage - 20%