Question

VOCABULARY REVIEW
Using the word pool on the right, find the correct word to match the definition. Write the word on the line after the
definition.
Group A Word Pool
1. A document sent by the insurance company to the provider and
the patient explaining the allowed charge amount, the amount
reimbursed for services, and the patient’s financial responsibilities
_______________________

2. An online marketplace where you can compare and buy
individual health insurance plans; state health insurance
exchanges were established as part of the Affordable Care Act
_______________________

3. Low-income Medicare patients who qualify for Medicaid for their
secondary insurance _______________________

4. A formal request for payment from an insurance company for
services provided _______________________

5. System used to determine how much providers should be paid
for services rendered; used by Medicare and many other health
insurance companies _______________________

6. An order from a primary care provider for the patient to see a
specialist or get certain medical services _______________________

7. A written agreement between two parties where one party (the
insurance company) agrees to pay another party (the patient) if
certain specified ci cumstances occur _______________________

8. A list of fixed fees for services ______________________

9. An organization that processes claims and provides
administrative services for another organization; often used by
self-funded plans _______________________

10. Poor, needy, impoverished _______________________

policy
claim
indigent
resource-based relative value
scale (RBRVS)
explanation of benefits (EOB)
fee schedule
qualified Medica e
beneficiaries (QMBs)
third-party administrator
(TPA)
health insurance exchange
referral

Answer 1

1. A document sent by the insurance company to the provider and the patient explaining the allowed charge amount, the amount reimbursed for services, and the patients financial responsibilities.------------------------ Explaining Of Benefits(EOB)

2. An online marketplace where you can compare and buy individual health insurance plans, state health insurance exchanges were established as part of the affordable care act--------------------Health Insurance Exchange

3. Low income medicare patients who qualify for medicaid for their secondary insurance------------------------Qualified Medicare Beneficiaries(QMBs)

4. A formal request for payment from an insurance company for service provided-----------Claim

5. System used to determine how much provider should be paid for service rendered ; used by medicare and many other health insurance companies--------------Resouce Based Relative Value Scale(RBRVS)

6. An order from a primary care provider for the patient to see a specialist or get certain medical services-------------------------------Referral

7.A written agreement between two parties where one party(the insurance company) agree to pay another party(the patient)if certain specified ci circumstances occur--------------Policy

8. A list of fixed fees for services---------------------------------Fee shedule

9. An organization that processes claims and provides administrative services for another organization often used by self funded plans -----------------------------Third Party Administrator(TPA)

10. Poor,needy,impoverished---------------------Indigent