A specified amount of money that the insured must pay before an insurance company will pay a claim.

Which among the following is NOT a type of cost-share?

Which among the following is a qualification to Medicare?

This is used to calculate eligibility for Medicaid and the Children's Health Insurance Program (CHIP).

A plan year that starts on the first day of the year until the last day of the year.

It is expressed as a percentage.

This is a complete listing of fees used by Medicare to pay doctors or other providers/suppliers.

It referes to a statement from health insurance plan describing what costs it will cover for medical care or products received.

Which of the following is NOT true about Workers' Compensation?

This allows the employer and Workers’ Comp insurance provider to potentially recover costs that the at-fault party is deemed responsible for.

Fixed or flat dollar amount paid by patients per service.

This pertains to the first payment made = to an insurance company to purchase the health plan a member enrolled in.

This step of RCM is to check if patient is covered to if procedures would require prior authorization.

This is the step of examining the necessity of medical services.

This is the individual who directed the patient for care to the provider rendering the services being reported.

It is the process by which the patient and his/her physician-led care team are cooperatively involved in ongoing health care management toward the shared goal of high quality, cost-effective medical care.

These are codes developed by CMS (the same organization that developed the CPT) and maintained by the AMA primarily correspond to services, procedures, and equipment not covered by the CPT codes.

This diagnostic coding is used only for inpatient, hospital settings in the U.S and has about 87,000 available codes.

Refers to a decision by the health plan that the treatment, test, or procedure is necessary to maintain or restore health or to treat a diagnosed medical problem.

These codes are shown with a plus sign (+), indicate that the code can only be listed after the primary or parent code has been listed.

This resubmission code meant Replacement of Prior Claim.

When a claim has been received but has not been approved or denied, finished or completed.

This is a coverage that members purchase on their own, on an individual or family basis.

Claim form used for facility services/claim.

In a CMS 1500, which block contains the patient's address?

Place of service 12.

A person who represents either party of an insurance claim.

Payment made periodically to keep an insurance policy in force.

An organization that offers health insurance at a fixed monthly premium with little or no deductible and works through a primary care provider.

A patient receiving ambulatory care at a hospital or other health facility without being admitted as a bed patient.

Insurance that is meant to offset medical expenses resulting from a catastrophic illness.

A doctor who agrees to accept an insurance company pre-established fee as the maximum amount to be collected.

This refer to an experienced insurance professional, essentially in the areas of long-term medical care, life insurance and annuities, which presides over a patient or client’s account and they are generally in the healthcare industry.

A contracted agreement between an insurance company and another company which provides special services to its members, such as prescription drugs or cancer treatment.

This is when a patient for billed amount not paid by their insurance plan because the charges are above the Usual and Customary Rate or because the insurer considered a procedure medically unnecessary.

Removal of sinus tarsi implant

80047–89398 is the code range for which section?

This refers to a secondary identifier that may be used in routing of pharmacy transactions.

Which of the following is not a private insurance carrier?

What is a clearinghouse and what purpose do they serve?