Medical Insurance Flashcards

Learn, Study, and Revise the key terms, words, and much more for the Medical Insurance with our quiz-based flashcards quizzes. Learn key terms, functions, and much more related to the Medical Insurance with the help of our flashcards quizzes with ease. ​

17 cards   |   Total Attempts: 288
  

Cards In This Set

Front Back
New patient (NP)
A patient who has not received professional services from a provider (or another provider with the same specialty in the same practice) within the past three years.
Returning patient 9established patient)
Patient that has seen the provider (or another provider who has the same specialty) within the past 3 years.
Information needed for new patients
1-Preregistration and scheduling information
2-Medical history
3-Patient/guarantor information & insurance Information
4-Assignment of benefits
5-Acknowledgement of Receipt of Notice of Privacy Practices
Referring physician
A referring physician send a patient to another physician for treatment.
Assignment of benefits
Authorization by a policy-holder that allows a health plan to pay benefits directly to a provider
Subscriber
The insured.
3 steps to establish financial responsiblity
1-Verify patient's eligibility for insurance benefits
2-Determine preauthorization & referral requirements
3-Determine the primary payer if more than one insurance plan is in effect.
3 things to verify with the patient's insurance co.
1-Patient's eligibility for benefits
2-Amount of copay
3-If the planned encounter is covered.
Primary insurance
Plan that pays first when patient has more than one insurance plan. The primary plan is the plan the patient has had the longer period of time.
Supplemental insurance
Fill the gap insurance policy
Secondary insurance
A second claim is sent to the secondary payer after the payment is received for the primary claim.
Coordination of benefits (COB)
A clause in an insurance policy that explains how the policy will pay if more than one insurance policy applies to the claim.
Birthday rule
The rule states that the parent whose day of birth is earlier in the calendar year is primary.
Encounter form
A listing of the diagnoses, procedures, and charges for a patient's visit; also called the superbill. Is completed by the provider during visit. The provider signs and dates it. Encounter forms should be prenumbered for accurate charge capture.
Charge capture
Office procedures that ensure that all billable services are recorded and reported for payment.