Free flashcards about med ins

The concept that every procedure or service reported to a third-pary payer must be linked to a condition that justifies the procedure or service is called

A claim was submitted for a left shoulder x-ray on an elderly patient, and the diagnosis reported on the claim was urinary tract infection. Reading housing benefit The claim was rejected because

Which termin describe the process of developing patient care plans for coordination and provision of care for complicated cases in a cost=effective manner?

If a plan allows enrollees to seek care from non-network providers, what effect will this have on the enrollees who sees a non-network provider? The enrollee will

W hen the provider is required to receive as payment in full whatever amount the insurance reimburses for services, the provider is agreeing to

The rule stating that the policyholder whose birth month and day occur earlier in the calendar year holds the primary policy for dependent children is the …rule

Initial office visit for a patient with left knee pain. Contact number housing benefit Detailed history and examination ws documented, along with low-complexity medical decision making

According to CPT, prolonged services codes are assigned in addition to other E/M services when treatment exceeds the time included in the CPT description by

Each relative value component is multiplied by the geographic cost practice (GCPI), and then each is further multiplied by a variable figure called the

Medicare participating providers commonly report actual fees to Medicare but adjust fees after payment is received.

Make a claim for housing benefit The difference between the fee reported and the payment received is a

The prospective payment system dependent on the patient’s principal diagnosis, comorbidities, complications, and principal and secondary procedures are called

The Medicare physician fee schedule amount for code 99210 is $100; the participating provider’s usual charge for this service is $125. Cancelling housing benefit claim Calculate Medicare reimbursement amount

When a provider documents justification for a patient seeking healthcare services, but no disorder is documented, the health insurance specialist usually assigns a(n)

The patient is a 39-year old female patient on lithium who is unable to discontinue the medication and does not desire to become pregnant while on medication. Housing benefit number bradford The patient therefore desires surgical sterilization.

Items 1-4 Block 21 of CM-1500 claim link listed diagnosis codes to their appropriate procedure service codes reported Block 24; known as….numbers

The birthday rule applies when dependent children living at home are covered by more than one health insurance policy. Housing and council tax benefit contact number The primary policy is determined by the parent

The is covered by two health insurance policies, his own employer’s group plan and his spouses’ employer’s group health plan. How much housing benefit would i get Which is primary policy?

Losses to third-party caused by the insured, by an object owned by the insured, or on the premises of the insured are covered by ….insurance

Which offers discounted healthcare services to subscribers who use designated healthcare providers but who also provides coverage for services rendered by healthcare providers who are NOT part of the network?

Business entities that pay taxes on profits generated by the corporation and distribute after-tax profits to shareholders and officers are …….organizations

Certain individuals who have resources at or below twice the standard allowed under the SSI program and income who have resources at or below 100% of the FPL do not have to pay mon Medicare premiums, deductibles,and coinsurance; are categorized as

The Medicaid program that makes cash assistance available on a time-limited basis for children deprived of support because of parent’s death,incapacity,absence, unemployment is the

A comprehensive healthcare program for which the Department of Veteran Affairs (VA) theshares the costs of covered healthcare services and supplies/supports with eligible beneficiaries is called