Insurance and Reimbursement Flashcards
7 cards from real RMA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Insurance and Reimbursement flashcards as text
What does a 'deductible' represent in a health insurance plan?
Answer: The amount a patient must pay before insurance begins to pay
The deductible is the amount the patient pays out of pocket before benefits kick in.
A 'copayment' is best described as:
Answer: A fixed dollar amount paid at the time of service
A copay is a set flat fee the patient pays for a covered service at the visit.
What is 'coinsurance'?
Answer: A percentage of allowed charges the patient pays after the deductible
Coinsurance is the percentage share of costs a patient pays once the deductible is met.
What is the purpose of 'precertification' (prior authorization)?
Answer: To obtain insurer approval before a service is performed
Precertification confirms the insurer will cover a planned service before it is rendered.
When a claim is denied for 'lack of medical necessity,' the medical assistant should first:
Answer: Review documentation and consider filing an appeal
Reviewing supporting documentation and appealing is the appropriate first step for such denials.
What does 'assignment of benefits' authorize?
Answer: Insurance payment to be sent directly to the provider
Assignment of benefits directs the insurer to pay the provider rather than the patient.
An 'in-network' provider has what relationship with an insurance plan?
Answer: A contracted agreement to accept negotiated rates
In-network providers contract with the plan to accept agreed-upon reimbursement rates.