Question

pilallon. u Uchinition of 57. The process of determining if a procedure or service is covered by the insurance plan and what the reimbursement is for that procedure is the definition of a. eligibility b. precertification. c. medical necessity. d. capitation 38. The provider is paid a set amount for cach enrolled person assigned to them, per period of time whether or not that person has received services is the definition of a. eligibility b. Precertification. c. medical necessity. d. capitation 29 Services and/or supplies used to treat the patient's diagnosis meet the accepled scancando practice is the definition of a. eligibility. b. precertification. c. medical necessity. d. capitation 40. To settle or determine judicially is the definition of a. copayment. b. deductible. c. co-insurance. d. adjudicate. 41. A set dollar amount that the policyholder must pay before the insurance company starts to pay for services is the definition of a. copayment. b. deductible. c. co-insurance. d. adjudicate. 42. After the deductible has been met the policyholder is responsible for a certain percentage of the bill is the definition of a. copayment b. deductible. c. co-insurance. d. adjudicate.

Answer 1

37. B

preauthorization" and "precertification" refer to the process by which a patient is pre-approved for coverage of a specific medical procedure or prescription drug.

38. D fixed per capita payment made periodically to a medical service provider (as a physician) by a managed care group (as an HMO) in return for medical care provided to enrolled individuals. 2 : a capitated health-care system.

39.C Services or supplies that are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice.”

40.D adjudicate

it is to make an official decision about who is right in (a dispute) : to settle judicially

41. B Deductible. The amount you pay for covered health care services before your insurance plan starts to pay.

42.