Which is usually offered either by a single insurance plan or as a joint venture among two or more insurance payers and provides subscribers or employees with a choice of HMO, PPO, or traditional health insurance plans?

A triple option plan is also called a __________ or flexible benefit plan because of the different benefit plans and extra coverage options provided through the insurer or third-party administrator.

Triple option plans are intended to prevent the problem of covering members who are sicker than the general population, which is called __________ selection.

The manual daily accounts receivable journal is also known as the __________, and it is achronologic summary of all transactions posted to individual patient ledgers/accounts on a specific date.

A policyholder or __________ is the person in whose name the insurance policy is issued.

Secondary insurance is the insurance plan that is billed after the primary insurance plan has paid its contracted amount and the provider's office has received a(n) __________ from the primary payer.

One reason to track unpaid claims is due to the payment error in which a patient erroneously cashes a check made out to both patient and provider, which is called a __________.

Managed care plans that are “federally qualified” and those that must comply with state quality review mandates, or __________, are required to establish quality assurance programs.

When applying the birthday rule, if policyholders have identical birthdays, the policy in effect the __________ is considered primary.

The computer-to-computer transfer of data between providers and third-party payers (or providers and health care clearinghouses) in a data format agreed upon by sending and receiving parties is called electronic __________.

Medicare and many states prohibit managed care contracts from containing __________, which prevent providers from discussing all treatment options with patients, whether or not the plan would provide reimbursement for services.

Which means the provider agrees to accept what the insurance company allows or approves as payment in full for the claim?

A managed care network of physicians and hospitals that have joined together to contract with insurance companies, employers, or other organizations to provide health care to subscribers for a discounted fee is called a(n) __________.

Any procedure or service reported on the claim that is not included on the master benefit list is a noncovered benefit and will result in claims __________.

Which the fixed amount the patient pays each time he or she receives health care services?

The Amendment to the HMO Act of 1973 allowed federally qualified HMOs to permit members to __________.

Which program resulted from the Balanced Budget Act of 1997 (BBA) and requires that quality assurance activities are performed to improve the functioning of Medicare Advantage (Medicare Part C) organizations?

Which person is responsible for paying the charges?

Medicare calls its remittance advice a(n) __________.

Some managed care plans contract out utilization management services to a utilization review organization (URO), which is an entity that __________.

Which is a legal action that can be used to recover a debt and is usually a last resort for a medical practice?

Which is the assignment of lower-level codes than documented in the record?

Which is a private, not-for-profit organization that assesses the quality of managed care plans in the United States and releases the data to the public for consideration when selecting a managed care plan?

A competitive medical plan (CMP) is an HMO that meets __________ eligibility requirements for a Medicare risk contract but is not licensed as a __________ qualified plan.