Maximum amount on which payment is based for covered health care services.
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Correct answer
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Ambulatory Care
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Ambulatory care is care given in the doctor's office or surgical center without an overnight stay.
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Appeal
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A request for your health insurer or plan to review a decision or a grievance.
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Correct answer
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Authorization
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Authorization is the approval of care, such as hospitalization, by an insurer or health plan. Your insurer or health plan may require pre-authorization before you're treated.
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Correct answer
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Balance Billing
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Balance billing is the practice of a provider billing you for all charges not paid by your insurance plan, even if those charges are above the plan's usual, customary and reasonable (UCR) charges or are considered medically unnecessary. Managed care plans and service plans generally prohibit providers from balance billing except for allowed copayments, coinsurance and deductibles.
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Coinsurance
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Coinsurance is a provision that limits an insurer's coverage to a certain percentage. If your insurance includes coinsurance, you'll be responsible for charges beyond those covered by your insurance.
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Correct answer
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Coordination of Benefits (COB)
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Coordination of benefits is an agreement between your insurers to prevent double payment for your care when more than one plan provides coverage. The agreement determines which insurer has primary responsibility for payment and which has secondary responsibility.
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Correct answer
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Copayment
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Copayment is the portion of a claim or medical expense that you must pay out of pocket. Copayment usually is a fixed amount.
Wrong answer
Correct answer
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Cost Share
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The share of costs by your insurance that you pay out of pocket. Cost share generally includes deductibles, coinsurance, copayments or similar charges. It does not include premiums, balance billing amounts for non-network providers or the cost of noncovered services.
Wrong answer
Correct answer
congratulations!
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Covered Charges
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Services that are typically covered under the terms of your contract with your insurance company. It is important to note that even though services may be covered charges, they are often subject to your deductible and coinsurance.
Wrong answer
Correct answer
congratulations!
Start over?
TRYAGAIN
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Current Procedural Terminology (CPT) Codes
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Medical professionals use this set of five-digit codes for billing and authorization of services.
Claims / Procedural Terminology
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Created on June 19, 2023
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Transcript
Allowed Amount
Flip
Maximum amount on which payment is based for covered health care services.
Wrong answer
Correct answer
congratulations!
Start over?
TRYAGAIN
Back
Ambulatory Care
Flip
Ambulatory care is care given in the doctor's office or surgical center without an overnight stay.
Wrong answer
Correct answer
congratulations!
Start over?
TRYAGAIN
Back
Appeal
Flip
A request for your health insurer or plan to review a decision or a grievance.
Wrong answer
Correct answer
congratulations!
Start over?
TRYAGAIN
Back
Authorization
Flip
Authorization is the approval of care, such as hospitalization, by an insurer or health plan. Your insurer or health plan may require pre-authorization before you're treated.
Wrong answer
Correct answer
congratulations!
Start over?
TRYAGAIN
Back
Balance Billing
Flip
Balance billing is the practice of a provider billing you for all charges not paid by your insurance plan, even if those charges are above the plan's usual, customary and reasonable (UCR) charges or are considered medically unnecessary. Managed care plans and service plans generally prohibit providers from balance billing except for allowed copayments, coinsurance and deductibles.
Wrong answer
Correct answer
congratulations!
Start over?
TRYAGAIN
Back
Coinsurance
Flip
Coinsurance is a provision that limits an insurer's coverage to a certain percentage. If your insurance includes coinsurance, you'll be responsible for charges beyond those covered by your insurance.
Wrong answer
Correct answer
congratulations!
Start over?
TRYAGAIN
Back
Coordination of Benefits (COB)
Flip
Coordination of benefits is an agreement between your insurers to prevent double payment for your care when more than one plan provides coverage. The agreement determines which insurer has primary responsibility for payment and which has secondary responsibility.
Wrong answer
Correct answer
congratulations!
Start over?
TRYAGAIN
Back
Copayment
Flip
Copayment is the portion of a claim or medical expense that you must pay out of pocket. Copayment usually is a fixed amount.
Wrong answer
Correct answer
congratulations!
Start over?
TRYAGAIN
Back
Cost Share
Flip
The share of costs by your insurance that you pay out of pocket. Cost share generally includes deductibles, coinsurance, copayments or similar charges. It does not include premiums, balance billing amounts for non-network providers or the cost of noncovered services.
Wrong answer
Correct answer
congratulations!
Start over?
TRYAGAIN
Back
Covered Charges
Flip
Services that are typically covered under the terms of your contract with your insurance company. It is important to note that even though services may be covered charges, they are often subject to your deductible and coinsurance.
Wrong answer
Correct answer
congratulations!
Start over?
TRYAGAIN
Back
Current Procedural Terminology (CPT) Codes
Flip
Medical professionals use this set of five-digit codes for billing and authorization of services.
Wrong answer
Correct answer
congratulations!
Start over?
TRYAGAIN
Back