Medical Billing Trivia
1.
Who represents either party of an insurance claim?
Answer:
Adjuster
Explanation:
An adjuster is a person who represents either party of an insurance claim. They are responsible for investigating and assessing the damages or losses claimed by the policyholder. Adjusters evaluate the validity of the claim, negotiate settlements, and ensure that the terms of the insurance policy are followed. They act as intermediaries between the insurance company and the policyholder, working to resolve the claim in a fair and efficient manner.
2.
What is a request for payment under an insurance contract or bond called?
Answer:
Claim
Explanation:
A request for payment under an insurance contractor bond is called a claim. This is the formal process by which an insured party requests compensation from the insurance company for a covered loss or damage. When an insured party experiences a loss or damage that falls within the terms of the insurance policy, they submit a claim to the insurance company to receive the agreed-upon benefits or reimbursement.
3.
What is the payment made periodically to keep an insurance policy in force called?
Answer:
Premium
Explanation:
A payment made periodically to keep an insurance policy in force is called a premium. This is the amount of money that an individual or business pays to an insurance company in exchange for coverage. The premium can be paid monthly, quarterly, semi-annually, or annually, depending on the terms of the insurance policy. It is essential to pay the premium on time to ensure that the insurance policy remains active and provides the necessary coverage.
4.
What is a person or institution that gives medical care called?
Answer:
Provider
Explanation:
A person or institution that gives medical care is called a "provider." This term generally includes doctors, nurses, clinics, and hospitals that offer health care services to patients. Providers are responsible for diagnosing, treating, and managing various health conditions. They play a crucial role in the healthcare system, ensuring that individuals receive the necessary medical attention and support for their health needs.
5.
What is the amount that the insured must pay before policy benefits begin called?
Answer:
Deductible
Explanation:
The amount that the insured must pay before policy benefits begin is called a "deductible." This is a predetermined amount of money that the policyholder is responsible for paying out-of-pocket before their insurance coverage kicks in and the insurance company starts paying for claims. Deductibles are a standard feature in many insurance policies, such as health, auto, and homeowners insurance, and they serve to share the cost of risk between the insurer and the insured.
6.
What is an organization that offers health insurance at a fixed monthly premium with little or no deductible and works through a primary care provider called?
Answer:
Health maintenance organization
Explanation:
A health maintenance organization (HMO) is an organization that offers health insurance at a fixed monthly premium with little or no deductible and works through a primary care provider. HMOs typically require members to choose a primary care physician (PCP) who coordinates their healthcare and provides referrals to specialists within the network. This type of organization focuses on preventive care and emphasizes the importance of regular check-ups and screenings. HMOs aim to provide comprehensive and cost-effective healthcare to their members.
7.
What is a patient who receives ambulatory care at a hospital or other health facility without being admitted as a bed patient called?
Answer:
Outpatient
Explanation:
An outpatient is a patient who receives medical care at a hospital or health facility without being admitted as a bed patient. They typically visit for consultations, treatments, or procedures and do not stay overnight. This term is used to distinguish them from inpatients who require hospitalization. It is important to note that carriers and adjusters are not relevant to this context and do not refer to patients receiving ambulatory care.
8.
What is an injury that prevents a worker from performing one or more of the regular functions of his job known as?
Answer:
Partial disability
Explanation:
Partial disability refers to an injury that hinders a worker from carrying out some, but not all, of their regular job functions. This means that the worker may still be able to perform certain tasks, but not to the same extent as before the injury. It implies a limitation or restriction in the worker's abilities, but not a complete inability to work. Therefore, partial disability is the appropriate term to describe an injury that prevents a worker from performing one or more of their regular job functions.
9.
What is a person who belongs to a group insurance plan called?
Answer:
Subscriber
Explanation:
A person who belongs to a group insurance plan is called a "subscriber." In the context of group insurance, a subscriber is typically the individual who holds and pays for the insurance policy. This term is often used in health insurance where employers provide plans in which employees enroll. Subscribers can include the primary holder of the insurance and can often extend coverage to include their family members, depending on the specifics of the policy.
10.
What is a sum of money provided in an insurance policy payable for covered services called?
Answer:
Benefits
Explanation:
A sum of money provided in an insurance policy payable for covered services is called "benefits." Benefits refer to the amounts that an insurance company pays out to a policyholder or a healthcare provider for the insured services under the terms of the insurance policy. These benefits cover various costs like medical procedures, hospital stays, or treatments, depending on the type of insurance and the specific policy's coverage details.
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