The amount an insurance carrier will pay for a covered medical services is the

Under an indemnity plan, benefits are determined on what basis?

Under a managed care plan, fixed fees for medical procedures and services are set by the

The file that contains the patient's medical and insurance information is the

The amount of money a patient must pay before the health plan will pay for services

A. copayments, deductibles, but not unknown noncovered services

B. copayments, charges for noncovered services and deductibles

C. only copayments and deductibles

D. only payment for noncovered services

B. copayments, charges for noncovered services and deductibles

When treatment is appropriate for the patient's diagnosis, it is said to be

The assignment of benefits allows the health plan to

Coding means

assigning proper numbers to identify the diagnoses and procedures on claims

The job of the medical insurance specialist is not really very important in a medical office.

True

False

The job description of a medical insurance specialist is determined by the physicians and practice manager.

True

False

The encounter form lists the diagnosis, medical services, and fees for a patient's visit.

True

False

The medical insurance specialist files the patient information form in the patient's medical record.

True

False

The only duty a medical insurance specialist has is to transmit health care claims to insurance carriers.

True

False

Finding the correct codes for diagnosis and treatment is performed by the medical specialist or a medical coder.

True

False

Once the health care claim is transmitted to the payer, the job of the medical insurance specialist is finished.

True

False

If a patient calls with a question about insurance, the call should be directed to the physician.

True

False

The term remittance advice means that the medical insurance specialist explains insurance problems to the patient.

True

False

If there seems to be a mistake in the amount of money paid by an insurance carrier, the medical insurance specialist should request a review.

True

False

Copay is the shortened version of which term?

• cooperative payment
• company payment
• coinsurance
• copayment 

Correct behavior in the medical office is called ____.

• ethics
• etiquette
• medically necessary
• HIPAA

After a medical assistant abstracts information about a patient's payer/plan, they contact the payer to verify three points. Which of the following is not one of these points?

• Patients' general eligibility for benefits
• The amount of the copayment or coinsurance required at the time of service.
• if the planned encounter is for a covered service that is medically necessary under the payer's rules
• the amount of the patient's premium

If a policyholder owes coinsurance of 30 percent and the charges are $100, what is the amount the insurance policy

will pay?

• $50
• $30
• $70
• $100

An electronic health record (EHR) is a ___.

• computerized record of a single visit with a physician
• computerized lifelong health care record for an individual
• computerized record of the patient's financial transactions
• computerized record of only childhood tests

Medically necessary means ______.

• the patient's diagnosis and procedures received are logically linked
• the patient needs the elective treatment
• the patient's diagnosis needs a second opinion
• the patient's procedures need a second opinion

the patient's diagnosis and procedures received are logically linked

An example of ____ is requiring patients to choose from a specific group of physicians.

• preauthorization policy
• cost-containment practice
• fee for service
• managed physician organization

The patient information form gives information about

A. the patient's examination results

B. the patient's discharge summary

C. the patient's progress notes

D. the patient's personal and insurance information

D. the patient's personal and insurance information