Affordable Care Act
The legislation that passed in 2010 which mandates minimum coverage that must be offered by every health insurer and requires every American to purchase health insurance, or face fines, taxes, and penalties is known as:
commercial health insurance plans
Blue Cross and B...
Affordable Care Act - ANSWER-The legislation that passed in 2010 which
mandates minimum coverage that must be offered by every health insurer and
requires every American to purchase health insurance, or face fines, taxes, and
penalties is known as:
commercial health insurance plans - ANSWER-Blue Cross and Blue Shield health
insurance plans are generally well-known examples of early years:
consumer driven health plans - ANSWER-What type of insurance plan typically
has high deductibles and lower monthly premiums?
D - ANSWER-Medicare Part ____was created to provide coverage for both generic
and brand-name drugs.
Only 15 percent above the participating provider fee schedule amount for the
service rendered. - ANSWER-Providers who sign a contract with Medicare to be a
participating provider receive payment directly from Medicare for services
rendered. Providers who choose not to be a participating provider can charge
what amount of the Medicare participating provider fee schedule amount for the
service rendered?
80 - ANSWER-What percent of the approved amount after the deductible is
satisfied will Medicare pay?
crossover - ANSWER-A ______is a claim that is automatically forwarded from
Medicare to a secondary insurer after Medicare has paid its portion of a service.
, Managed Care - ANSWER-is a system of health care that integrates the delivery
and payment of health care for covered persons (patients, or subscribers) by
contracting with selected providers for comprehensive health care services at a
reduced cost.
A - ANSWER-Part ____of Medicare is for hospital coverage, and any person who
is receiving monthly Social Security benefits is automatically enrolled.
B - ANSWER-Part ___ of Medicare is for payment of other medical expenses,
including office visits, X-ray and laboratory services, and the services of a
provider in or out of the hospital.
C - ANSWER-Part ___is the segment of Medicare that enables beneficiaries to
select a managed care plan as their primary coverage.
accept assignment - ANSWER-provider agrees to accept the insurer's payment as
payment in full for the service provided
advance beneficiary notice (ABN) - ANSWER-document used to notify a Medicare
beneficiary that is either unlikely that Medicare will pay or certain that Medicare
will not pay for the service they are going to be provided; beneficiaries are
required to sign this document if they wish to have the service with the
understanding that they will responsible for payment
allowed amount - ANSWER-the maximum amount an insurer will pay for any
given service
assignment of benefits - ANSWER-the authorization, by signature of the patient,
for payment to be made directly by the patient's insurance to the provider for
services
beneficiary - ANSWER-person entitled to benefits of an insurance policy; this
term is most widely used by Medicare
birthday rule - ANSWER-a means to identify primary responsibility in insurance
coverage; identifies the primary insurance carrier when children have coverage
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