MED 126 Chapter 48 and 49 Exam Review

Individual who has a specific insurance plan

Legal process by which the debts of an individual are resolved if they cannot pay in full

Insurance carrier or managed care organization that pays health insurance claims

the govt program for low-income people that is funded both by the federal govt and the state

An indication on the ins claim form that the sig of the pt is maintained by the office to bill

The process by which a pt makes an appt w/ a specialist w/o prior auth from his pcp

Legal requirement to disclose the terms of a loan in terms that the borrower can understand

System to establish the Medicare fee schedule for Med Part B based on the service and location

insurance that covers lost wages and health care of injured workers

messages encouraging payment of the bill, usually attached to the monthly statement

The insurance company that must be billed first for any individual

Auth for insurance reimbursement to be made directly to the provider rather than the pt

One insurance policy that covers a group of people

A Govt health ins program that covers dependents of Veterans with disabilities

statement issued by the insurance carrier explaining reimbursement

Movement in health care based on reducing costs while proving high quality care

Physician who does not contract with a third party payor

Federal health ins plan for elderly, permanently disabled, end stage kidney disease

Written notification to a pt w/original Medicare that a covered service must be paid if denied

An obligation to provide compensation for loss or damage

method of paying for ins in which a fixed amount is paid regardless of the care received

Both parents of a child have a family plan ins of the parent whose birthday is first covers kid

Statement issued by Medicare explaining reimbursement for specific procedures for denial

A fixed amount of money that the patient must pay for any health service

Bill sent to a pt that contains charges, payments, adjustments and a balance due

A gov't ins plan that provides medical care to spouses and dependents of active duty people

A check that exceeds the amount of funds in a bank account

The process of finding out how long specific account balances have been outstanding

A system to determine Medicare reimburs for a hospital stay on the basis of the pt's diagnosis

An insurance carrier's official list of covered medications to be used by network

system for establishing amount carrier will pay, based off price for most freq charge for doc

A firm that is in the business of collecting overdue accounts

ins reimbursement that is directly related to the services provided

A % of the allowed charge for health services, which the patient is responsible for paying

Account for which no billing information for non-coverage

The directing of a patient to a specialist by their pcp

Enrollment status related to a health insurance plan

An insurance company

negative balance on a patient account usually a result of an over payment

total amount owed