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Exam 6: Traditional Fee For Service/Private Plans

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Question 1

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The two basic categories of health insurance are FFS and:

A) managed care.
B) group insurance.
C) individual policies.
D) health savings accounts.

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Question 2

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Prior to the passage of the Affordable Care Act,a _____________ was the most common way to provide individuals access to health insurance if the person had been denied coverage because of a preexisting condition and had been without coverage for a period of at least 6 months.

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high-risk ...

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Question 3

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A PAR provider agrees to accept the amount paid by the insurance carrier as "payment in full" after both the deductible and copayment have been met.

The federal act that sets minimum standards for pension plans for private industry is:

The earliest and probably best known commercial insurer in this country is:

Most healthcare providers in the United States accept Blue Cross and Blue Shield patients.

One of the provisions of healthcare reform was the removal of lifetime caps on insurance.

If a claim is denied as "untimely,":

The time limit for filing claims:

Explain the function of a fiscal intermediary/Medicare administrative contractor.

Many Americans obtain health insurance owing to their employment through what is commonly referred to as:

Providers who do not contract with a particular insurance carrier are called nonPARs.

To make sure electronic claims have been received by the payer (or clearinghouse),the health insurance professional should review the ________________,a report that the carrier normally sends after each electronic transmission.

The kind of health insurance paid for by a business entity other than the government is called:

Prior to submitting a claim,the healthcare professional should:

A document prepared by the carrier that gives details of how the claim was adjudicated is called a/an ________________.

Eliminating a certain specialty of health services (e.g.,vision or dental care)from coverage is called a "carve out."

Name the three out-of-pocket costs in a fee-for-service plan.

Another term for "insurance cap" is:

The Affordable Care Act requires that plans sold to individuals and small businesses provide a minimum package of services in 10 categories called