Questions and Answers | A+
Score Assured
Advance Beneficiary Notice (ABN) - ANSWER ✔✔A form provided to
the patient when the provider believes Medicare will probably not pay for
services received
Allowed Amount - ANSWER ✔✔The maximum amount a third-party
payer will pay for a particular procedure or service
Copayment - ANSWER ✔✔a small fixed fee paid by the patient at the
time of an office visit
,Coinsurance - ANSWER ✔✔a provision under which both the insured
and the insurer share the covered losses, typically 80:20
deductible - ANSWER ✔✔specific amount of money a patient must
pay out of pocket before the insurance carrier begins paying
Explanation of Benefits - ANSWER ✔✔a form created by the
insurance company to explain what charges were covered, denied, or
need more documentation based on the claims submitted by the
physician's office
Participating provider (PAR) - ANSWER ✔✔Providers who agree to
write off the difference between the amount charged by the provider and
the approved fee established by the insurer
Medicare - ANSWER ✔✔A federal program of health insurance for
persons 65 years of age and older by Part A (hospitalization) or Part B
(routine medical office visits)
Tricare - ANSWER ✔✔U.S. government health insurance plan for all
military personnel
CHAMPVA - ANSWER ✔✔covers surviving spouses and dependent
children of veterans who died as a result of service-related disabilities
,Medicaid - ANSWER ✔✔provides health insurance to the medically
indigent population through a cost-sharing program between federal and
state governments for those who meet specific eligibility criteria
Managed Care - ANSWER ✔✔is an umbrella term for plans that
provide health care in return for preset scheduled payments and
coordinated care through a defined network of providers and hospitals
CMS-1500 form - ANSWER ✔✔Standard insurance form used by all
government and most commercial insurance payers.
- 33 blocks
- divided into three section
CMS-1500 Section 1 - ANSWER ✔✔Carrier Block: contains the
address of the insurance carrier and is located at the top of the form
CMS-1500 Section 2 - ANSWER ✔✔Patient/insured section: contains
information about the patient or insured; includes boxes 1-13
CMS-1500 Section 3 - ANSWER ✔✔Physician/Supplier Section:
contains information about the physician or supplier: boxes 14-33
Supine Position - ANSWER ✔✔
Dorsal Recumbent Position - ANSWER ✔✔
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, Sims' Position - ANSWER ✔✔
Knee-elbow position - ANSWER ✔✔
Fowler's Position - ANSWER ✔✔
Lithotomy Position - ANSWER ✔✔
Epidural Injection - ANSWER ✔✔epidural space of the spine
Intra-arterial Injection - ANSWER ✔✔injection into an artery (to break
up clots)
Intra-articular Injection - ANSWER ✔✔injection into joint space
Intradermal Injection - ANSWER ✔✔Skin of the upper chest,
forearms, upper pack. 5-15º angle
intramuscular injection - ANSWER ✔✔deltoid, vastus lateralis,
ventrogluteal muscles
Intraosseous Injection - ANSWER ✔✔Bone marrow
Intraperitoneal Injection - ANSWER ✔✔within the peritoneal cavity
Intrapleural Injection - ANSWER ✔✔pleural space (lungs)
Intrathecal Injection - ANSWER ✔✔Subarachnoid space (brain)