Match the following

-Percentage of the cost of covered services that the policyholder must pay
A) deductible
B) electronic remittance advice (ERA)
C) conversion factor
D) coinsurance
E) relative value unit
F) reason code
G) adjudication
H) copayment
I) withhold
J) allowed charge

Question

Match the following

-Percentage of the cost of covered services that the policyholder must pay
A) deductible
B) electronic remittance advice (ERA)
C) conversion factor
D) coinsurance
E) relative value unit
F) reason code
G) adjudication
H) copayment
I) withhold
J) allowed charge

Quizplus · Accepted Answer

Coinsurance is the percentage of the cost of covered services that the policyholder must pay after the deductible has been met.

Answer: A
 Deductible is the amount the policyholder must pay out of pocket for covered services before the insurance plan begins to pay.

Answer: H
 Copayment is a fixed amount that the policyholder must pay for covered services at the time of service. It is a set amount, not a percentage like coinsurance.

Answer: J
 Allowed charge is the maximum amount that the insurance plan will pay for a covered service. Providers are not allowed to bill patients for any amount above the allowed charge.

Answer: E
 Relative value unit (RVU) is a measure of the value of medical services used to determine payment amounts for physicians. It is based on the complexity and time involved in providing the service.

Answer: C
 Conversion factor is the monetary value assigned to each RVU to determine payment amounts for physicians.

Answer: G
 Adjudication is the process of determining the payment amount for a claim based on the contract between the insurance plan and the provider.

Answer: B
 Electronic remittance advice (ERA) is an electronic document that details the payment and adjustment information for a claim. It is sent to providers to inform them of the payment amount and reason codes for any denied or adjusted claims.

Answer: F
 Reason code is a code used to explain why a claim was denied or adjusted. It is included on an ERA and other payment documents.

Answer: I
 Withhold is a percentage of payment that is withheld by an insurance plan as an advance payment for potential future overpayments or compliance with quality measures.

Match the Following -Percentage of the Cost of Covered Services That the Policyholder