Free Medical Insurance Billing Question and Answers — Questions and Answers
Question 1: A periodic payment made to keep an insurance coverage active is referred to as ________.
- Premium (Correct answer)
- Time limit
- Fee-for-service
- Coinsurance
Correct answer: Premium
A premium is the regular payment, typically monthly or annually, that an individual or company makes to an insurance provider to maintain an active insurance policy. This payment ensures that the policyholder remains covered for the benefits outlined in their agreement. It is the cost of maintaining continuous insurance coverage.
Question 2: An amount that the insured must pay before receiving policy benefits is referred to as _________.
- Extended benefits
- Catastrophic
- Indemnity
- Deductible (Correct answer)
Correct answer: Deductible
A deductible is the specific amount of money that an insured individual must pay out-of-pocket for covered medical expenses before their insurance plan begins to pay. It acts as a threshold, requiring the policyholder to bear initial costs before policy benefits kick in. This mechanism helps share the cost of healthcare between the insured and the insurer.
Question 3: The_________________ is the person who speaks on behalf of either party in an insurance claim.
- Provider
- Doctor
- Subscriber
- Adjuster (Correct answer)
Correct answer: Adjuster
An adjuster is a professional who investigates insurance claims to determine the extent of the company's liability and the amount of loss or damages payable under a policy. They act as a representative for the insurance company or, in some cases, for the policyholder, negotiating and settling claims. Therefore, they speak on behalf of either party in an insurance claim.
Question 4: To properly code in the section, you will need to be familiar with the information in these.
- Glossary
- Guidelines (Correct answer)
- Notes
- Appendices
Correct answer: Guidelines
In medical coding, guidelines provide the essential rules and instructions for accurate code assignment. These guidelines ensure consistency and compliance with coding standards, making them crucial for proper code selection within any coding section. Without adhering to these instructions, coding errors are likely to occur, impacting billing and reimbursement.
Question 5: A(n)_______________ is a person or organization that provides medical care.
- Insurance agent
- Adjuster
- Third-party payer
- Provider (Correct answer)
Correct answer: Provider
A provider, in the context of medical billing, refers to any individual or organization that furnishes healthcare services. This includes doctors, hospitals, clinics, and other healthcare professionals who deliver medical care to patients. They are the entities that bill for services rendered.
Question 6: A(n)_______________ is the name of the request for payment made under an insurance contractor bond.
- Claim (Correct answer)
- Insurance application
- Total disability
- Dual choice request
Correct answer: Claim
A claim is a formal request submitted to an insurance company for payment of services rendered. In medical billing, this document details the medical procedures performed and diagnoses given, seeking reimbursement from the insurer for the costs incurred by the patient. It initiates the payment process under an insurance policy.
Question 7: A(n)_______________ is the name of a company that provides health insurance for a set monthly cost with little to no deductible and through a primary care physician.
- Private health provider
- Member physician
- Preferred provider
- Health maintenance organization (Correct answer)
Correct answer: Health maintenance organization
A Health Maintenance Organization (HMO) is a type of managed care health insurance plan that provides healthcare services for a fixed monthly premium. HMOs typically require members to choose a primary care physician (PCP) who then refers them to specialists within the network, often resulting in lower out-of-pocket costs and little to no deductible. This structure emphasizes preventative care and cost control.
Free Medical Insurance Billing Question and Answers
A periodic payment made to keep an insurance coverage active is referred to as ________.