Knowledge Evaluation - Medical Billing Trainer

1. Define the following term.

Deductible:

A provision that applies when a person is covered under more than one group medical program.

A deductible is the amount that a patient must pay for medical care before their insurance coverage kicks in and covers the remaining balance. It is a form of cost sharing where the patient is responsible for a specified amount of approved charges for covered medical services. The deductible is the total amount that a member of a health plan must pay for services before their plan starts covering the costs of care.

Explanation

A deductible is the amount that a patient must pay for medical care before their insurance coverage kicks in and covers the remaining balance. It is a form of cost sharing where the patient is responsible for a specified amount of approved charges for covered medical services. The deductible is the total amount that a member of a health plan must pay for services before their plan starts covering the costs of care.

2. Define the following term.

Co-insurance:

The amount the patient pays for medical care before insurance covers the balance

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Explanation

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3. Define the following term.

Capitation:

Capitation refers to a form of payment made by the insurance company to a physician in advance of medical services being provided. This prepayment is usually a fixed amount, typically paid on a monthly basis, and is intended to cover the cost of services for a member of a specific health plan, such as an HMO.

Explanation

Capitation refers to a form of payment made by the insurance company to a physician in advance of medical services being provided. This prepayment is usually a fixed amount, typically paid on a monthly basis, and is intended to cover the cost of services for a member of a specific health plan, such as an HMO.

4. Define the following term.

Ancillary Providers:

Services over and above physician services, including laboratory, radiology, home health and skilled nursing facilities.

Surgery done in the physician’s office or at a surgical center, and not requiring an overnight stay.

How physician's services are identified and defined.

Ancillary providers refer to services that are provided in addition to physician services. These services can include laboratory tests, radiology procedures, home health care, and skilled nursing facilities. They are considered separate from the primary care provided by physicians. This definition does not include the other options mentioned in the question, such as surgery done in the physician's office or the process of Medicare/insurance payments.

Explanation

Ancillary providers refer to services that are provided in addition to physician services. These services can include laboratory tests, radiology procedures, home health care, and skilled nursing facilities. They are considered separate from the primary care provided by physicians. This definition does not include the other options mentioned in the question, such as surgery done in the physician's office or the process of Medicare/insurance payments.

5. Define the following term.

Carve-out Policy:

The process which allows you to process a group of entries, versus one entry at a time.

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Explanation

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