Insurance Handbook for the Medical Office 13 th edition. Chapter 03 Basics of Health Insurance. Introduction to Health Insurance. Describe the history of insurance in the United States. Explain the reasons for the rising cost of health care.
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Basics of Health Insurance
Describe the history of insurance in the United States.
Explain the reasons for the rising cost of health care.
Discuss how the Patient Protection and Affordable Care Act will reform health care.
State four concepts of a valid insurance contract.
Explain the difference between an implied and an expressed physician-patient contract.
Define common insurance terms.
Insurance is one of the world’s largest businesses
Health insurance offsets the costs of illness and/or injury
Escalating medical costs have limited insurance coverage options
Patients may have more than one insurance policy to defray health care costs
Patient Protection and Affordable Care Act
Health Care and Education Reconciliation Act of 2010
Premium: monthly, quarterly, or annual fee to keep insurance active
Deductible: specific amount of money paid each year before policy benefits begin
Coinsurance/copayment: cost-sharing requirement in which the insured assumes a percentage of the fee or pays a specific amount for covered services
List the ways a person can obtain health insurance.
State the types of health insurance coverage.
Describe in general terms the important federal, state, and private health insurance plans.
Relate the entire billing process to simple and complex medical cases.
Explain the administrative life cycle of a physician-based insurance claim from completion to third-party payer processing and payment.
Determine the appropriate questions to ask a patient for a complete patient registration form.
List the types of computerized signatures for documents and insurance claims.
Demonstrate how to track submitted insurance claims.
List the functions of an aging accounts receivable report in a computerized practice management system or a “tickler” file in a paper environment.
Explain how insurance billing and coding information can be kept up to date.
Describe the proper information to post to the patient’s financial account after claims submission and payment received.
The Civilian Health and Medical Program of the Department of Veteran Affairs (CHAMPVA)
Competitive Medical Plan (CMP)
Disability Income Insurance
Exclusive Provider Organization (EPO)
Foundation of Medical Care (FMC)
Health Maintenance Organization (HMO)
Independent or Individual Practice Association (IPA)
Maternal and Child Health Program (MCHP)
Point-of-Service Plan (POS)
Preferred Provider Organization (PPO)
Unemployment Compensation Disability (UCD)
Veterans Affairs Outpatient Clinic (VA)
Workers’ Compensation Insurance (WC)
Manually preparing claims for submission
In-office electronic filing by fax or computer
Contracting with an outside service bureau
Use of a telecommunications networking system
Patient Signature Release
Financial Statement (Ledger Card)