Medical Billing Trivia

Clinically Reviewed by Amanda Nwachukwu
Amanda Nwachukwu, Pharm(D) |
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Amanda, holding a Doctorate in Pharmacy from Texas Tech University Health Sciences Center, adeptly simplifies complex medical concepts into accessible content. With clinical proficiency, she ensures optimal patient care, while her adept medical writing skills facilitate comprehension and accessibility of healthcare information. Utilizing her education and expertise, Amanda meticulously reviews medical science quizzes, ensuring accuracy and clarity. Her commitment to excellence in healthcare education drives her passion for delivering quality content, ultimately benefiting both healthcare professionals and patients alike.
, Pharm(D)
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| By Medquiz
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Medquiz
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Quizzes Created: 1 | Total Attempts: 39,127
Questions: 15 | Viewed: 39,145

1.

A person who represents either party of an insurance claim is the_________________.

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.

A request for payment under an insurance contractor bond is called a(n)_______________.

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.

Payment made periodically to keep an insurance policy in force is 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.

A person or institution that gives medical care is a(n)_______________.

Answer: Provider
Explanation:
A person or institution that gives medical care is commonly referred to as a provider. They may include doctors, nurses, hospitals, clinics, and other healthcare professionals or facilities that offer medical services to patients. Providers are responsible for diagnosing and treating illnesses, injuries, and other health conditions, and they play a crucial role in delivering healthcare services to individuals in need.
5.

An amount the insured must pay before policy benefits begin is called_

Answer: Deductible
Explanation:
A deductible is the amount that an insured person must pay out of pocket before their insurance policy benefits kick in. It is a predetermined fixed amount that the insured is responsible for paying towards covered expenses. Once the deductible is met, the insurance company will then start covering the remaining costs as outlined in the policy. The purpose of a deductible is to share the financial burden between the insured and the insurance company, and to discourage unnecessary claims.
6.

An organization that offers health insurance at a fixed monthly premium with little or no deductible and works through a primary care provider is called a(n)_______________.

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.

A patient receiving ambulatory care at a hospital or other health facility without being admitted as a bed patient is called a(n)______________.

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.

An injury that prevents a worker from performing one or more of the regular functions of his job would be known as a_______________.

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.

One who belongs to a group insurance plan is called________________.

Answer: Subscriber
Explanation:
In the context of a group insurance plan, the term "subscriber" refers to an individual who belongs to the plan. This person is typically the policyholder or the main member of the group who enrolls in the insurance coverage on behalf of the group. The subscriber is responsible for paying the premiums and may also be responsible for managing the insurance benefits for the other members of the group. Therefore, "subscriber" is the correct answer to the question.
10.

A sum of money provided in an insurance policy payable for covered services is called___________.

Answer: Benefits
Explanation:
In an insurance policy, the sum of money provided for covered services is referred to as benefits. This refers to the amount that the insurance company will pay out to the policyholder for any eligible claims or services covered under the policy. Deductible is the amount that the policyholder must pay out of pocket before the insurance coverage kicks in. Dues payable refers to any outstanding payments or fees that are owed. Premium is the amount paid by the policyholder to the insurance company for the coverage provided.
11.

To prevent the insured from receiving a duplicate payment for losses under more than one insurance policy is called_____________.

Answer: Coordination of benefits
Explanation:
Coordination of benefits refers to the process of preventing the insured from receiving duplicate payments for losses under multiple insurance policies. This ensures that the insured does not receive more than the actual amount of the loss, and helps in avoiding fraud or overcompensation. By coordinating benefits, insurance companies can determine the primary and secondary coverage, and allocate the responsibility of payment accordingly. This helps in streamlining the claims process and ensuring fair and efficient distribution of benefits to the insured.
12.

When a patient has health insurance, the percentage of covered services that is the responsibility of the patient to pay is known as_______________.

Answer: Coinsurance
Explanation:
Coinsurance is the answer. When an individual possesses health insurance, coinsurance refers to the percentage of the total cost of covered services that the patient is obligated to pay. This entails a shared financial responsibility between the insurance provider and the insured individual, with the latter contributing a specified percentage of the expenses for covered healthcare services.
13.

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

Answer: Major medical
Explanation:
Major medical insurance is designed to provide coverage for significant medical expenses that result from a catastrophic illness. This type of insurance typically has higher deductibles and out-of-pocket costs, but offers more comprehensive coverage for major medical events such as surgeries, hospital stays, and expensive treatments. It helps individuals and families protect themselves financially in the event of a serious illness or injury.
14.

An unexpected event which may cause injury is called_______________.

Answer: Accident
Explanation:
An unexpected event which may cause injury is called an accident. Accidents can occur due to various reasons and can result in physical harm or injury to individuals. This term is commonly used in insurance policies to refer to incidents that are sudden, unforeseen, and unintentional, leading to bodily harm or damage. The other options provided, such as "dread disease rider" and "adjuster," do not accurately describe an unexpected event that may cause injury.
15.

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

Answer: Participating physician
Explanation:
A participating physician is a doctor who agrees to accept an insurance company's pre-established fee as the maximum amount to be collected. This means that the doctor is willing to provide medical services to patients who have insurance coverage at a predetermined rate set by the insurance company. By being a participating physician, the doctor ensures that they will receive payment directly from the insurance company, rather than having to bill the patient for any remaining balance after insurance reimbursement.
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