MedCerts/WK#1: Insurance and
Billing, and Coding Essentials
What is a copayment?
-Amount paid by policyholder/beneficiary annually.
-Fixed amount paid by policyholder/beneficiary for service.
-Percentage of charge paid by policyholder/beneficiary. -
Ans>>>Fixed amount paid by policyholder/beneficiary for
service.
What is a deductible?
-Amount paid by policyholder/beneficiary annually.
-Fixed amount paid by policyholder/beneficiary for service.
-Percentage of charge paid by policyholder/beneficiary. -
Ans>>>Amount paid by policyholder/beneficiary annually.
What is coinsurance?
-Amount paid by policyholder/beneficiary annually.
,-Fixed amount paid by policyholder/beneficiary for service.
-Percentage of charge paid by policyholder/beneficiary. -
Ans>>>Percentage of charge paid by policyholder/beneficiary.
What is a premium?
-Approval for coverage prior to providing a service
-A contract fixed prepayment paid by the payer to a primary
care physician (PCP).
-Cost of insurance paid by policyholder. - Ans>>>Cost of
insurance paid by policyholder.
What is preauthorization?
-Approval for coverage prior to providing a service.
-A contract fixed prepayment paid by the payer to a primary
care physician (PCP).
-Cost of insurance paid by policyholder. - Ans>>>Approval for
coverage prior to providing a service.
What is capitation?
-Approval for coverage prior to providing a service.
-A contractual fixed prepayment paid by the payer to a primary
care physician (PCP).
,-Cost of insurance paid by policyholder. - Ans>>>A contractual
fixed prepayment paid by the payer to a primary care physician
(PCP).
Which of the following statements describes a major trend in
the healthcare industry today?
-A state fund covers all expenses that are not approved by the
health plans.
-Patients are required to pay less out-of-pocket costs as
insurance companies assume more costs.
-There is a shift of payment responsibility from employers and
insurance companies to patients.
-Employers are now paying 100 percent of patient benefits with
no out-of-pocket expenses to the patient. - Ans>>>-There is a
shift of payment responsibility from employers and insurance
companies to patients.
Which of the following statements are true of insurance
specialist careers? Select all that apply.
*Good, experienced billing/coding specialists are in short
supply.
, *The market is flooded with experienced medical insurance
specialists.
*Employment in positions that help providers handle insurance
demands is growing.
*The work of an insurance specialist is an increasingly complex
job.
*There is no opportunity for career development for insurance
specialists. - Ans>>>*Good, experienced billing/coding
specialists are in short supply.
*Employment in positions that help providers handle insurance
demands is growing.
*The work of an insurance specialist is an increasingly complex
job.
Movement of monies into or out of a business is called ______.
-accounts receivable
-cash flow
-accounts payable
-cash stratification - Ans>>>-cash flow
Billing, and Coding Essentials
What is a copayment?
-Amount paid by policyholder/beneficiary annually.
-Fixed amount paid by policyholder/beneficiary for service.
-Percentage of charge paid by policyholder/beneficiary. -
Ans>>>Fixed amount paid by policyholder/beneficiary for
service.
What is a deductible?
-Amount paid by policyholder/beneficiary annually.
-Fixed amount paid by policyholder/beneficiary for service.
-Percentage of charge paid by policyholder/beneficiary. -
Ans>>>Amount paid by policyholder/beneficiary annually.
What is coinsurance?
-Amount paid by policyholder/beneficiary annually.
,-Fixed amount paid by policyholder/beneficiary for service.
-Percentage of charge paid by policyholder/beneficiary. -
Ans>>>Percentage of charge paid by policyholder/beneficiary.
What is a premium?
-Approval for coverage prior to providing a service
-A contract fixed prepayment paid by the payer to a primary
care physician (PCP).
-Cost of insurance paid by policyholder. - Ans>>>Cost of
insurance paid by policyholder.
What is preauthorization?
-Approval for coverage prior to providing a service.
-A contract fixed prepayment paid by the payer to a primary
care physician (PCP).
-Cost of insurance paid by policyholder. - Ans>>>Approval for
coverage prior to providing a service.
What is capitation?
-Approval for coverage prior to providing a service.
-A contractual fixed prepayment paid by the payer to a primary
care physician (PCP).
,-Cost of insurance paid by policyholder. - Ans>>>A contractual
fixed prepayment paid by the payer to a primary care physician
(PCP).
Which of the following statements describes a major trend in
the healthcare industry today?
-A state fund covers all expenses that are not approved by the
health plans.
-Patients are required to pay less out-of-pocket costs as
insurance companies assume more costs.
-There is a shift of payment responsibility from employers and
insurance companies to patients.
-Employers are now paying 100 percent of patient benefits with
no out-of-pocket expenses to the patient. - Ans>>>-There is a
shift of payment responsibility from employers and insurance
companies to patients.
Which of the following statements are true of insurance
specialist careers? Select all that apply.
*Good, experienced billing/coding specialists are in short
supply.
, *The market is flooded with experienced medical insurance
specialists.
*Employment in positions that help providers handle insurance
demands is growing.
*The work of an insurance specialist is an increasingly complex
job.
*There is no opportunity for career development for insurance
specialists. - Ans>>>*Good, experienced billing/coding
specialists are in short supply.
*Employment in positions that help providers handle insurance
demands is growing.
*The work of an insurance specialist is an increasingly complex
job.
Movement of monies into or out of a business is called ______.
-accounts receivable
-cash flow
-accounts payable
-cash stratification - Ans>>>-cash flow
