MA 105 Exam 1 Study Guide
Deductible - correct answer-a specific amount of money paid before policy benefits begin
Copay - correct answer-the amount of money a managed care plan requires a patient to pay
in the office prior to being seen by a provider
Coinsurance - correct answer-cost sharing requirement where the insured pays a
percentage of the fee
Exclusion - correct answer-a service never covered within a health insurance policy
Preexisting - correct answer-conditions existing and treated prior to the effective date of a
policy
Eligibility verification - correct answer-check and confirm that a patient is a member of the
insurance plan and the provided identification number is correct
Premium - correct answer-an amount of money that is usually paid monthly to keep a policy
in force.
claim adjudicator - correct answer-an insurance claim representative
Daysheet - correct answer-a record sheet used to record daily business transactions
Ledger - correct answer-a patient's financial accounting record
What are some other terms that are used to refer to an insured individual? - correct
answer-policy holder
subscriber
member
Describe the differences between the terms Preauthorization, Precertification, and
Predetermination. - correct answer-Preauthorization determines if a procedure is covered
and medically necessary
Precertification is discovers whether a treatment (surgery, hospitalization, tests) is covered
under a patient contract
Guarantor - correct answer-An individual who promises to pay a medical bill by signing an
agreement or by accepting treatment
Define the birthday rule - correct answer-It indicates which parent has primary coverage for a
child; and is determined by the parent who's birthday comes first in the calendar year
Deductible - correct answer-a specific amount of money paid before policy benefits begin
Copay - correct answer-the amount of money a managed care plan requires a patient to pay
in the office prior to being seen by a provider
Coinsurance - correct answer-cost sharing requirement where the insured pays a
percentage of the fee
Exclusion - correct answer-a service never covered within a health insurance policy
Preexisting - correct answer-conditions existing and treated prior to the effective date of a
policy
Eligibility verification - correct answer-check and confirm that a patient is a member of the
insurance plan and the provided identification number is correct
Premium - correct answer-an amount of money that is usually paid monthly to keep a policy
in force.
claim adjudicator - correct answer-an insurance claim representative
Daysheet - correct answer-a record sheet used to record daily business transactions
Ledger - correct answer-a patient's financial accounting record
What are some other terms that are used to refer to an insured individual? - correct
answer-policy holder
subscriber
member
Describe the differences between the terms Preauthorization, Precertification, and
Predetermination. - correct answer-Preauthorization determines if a procedure is covered
and medically necessary
Precertification is discovers whether a treatment (surgery, hospitalization, tests) is covered
under a patient contract
Guarantor - correct answer-An individual who promises to pay a medical bill by signing an
agreement or by accepting treatment
Define the birthday rule - correct answer-It indicates which parent has primary coverage for a
child; and is determined by the parent who's birthday comes first in the calendar year
