T&F & MULTIPLE CHOICE CHAPTER 13

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30 terms · CHAPTER 13 HEALTH INSURANCE

FALSE (PREPAID)

BLUE CROSS AND BLUE SHIELD BEGAN AS TWO SEPARATE FEE-FOR-SERVICE HEALTH PLANS

TRUE

THE AMERICAN HOSPITAL ASSOCIATION (AHA) IS THE APPROVING AGENCY FOR ACCREDITATION OF NEW PREPAID HOSPITALIZATION PLANS

TRUE

FOR-PROFIT CORPORATIONS PAY TAXES ON PROFITS GENERATED BY THE CORPORATION'S FOR-PROFIT ENTERPRISES AND PAY DIVIDENDS TO SHAREHOLDERS ON AFTER-TAX PROFITS

FALSE

BCBS PLANS DO NOT NEED TO OBTAIN APPROVAL FROM THEIR RESPECTIVE STATE INSURANCE COMMISSIONERS FOR ANY RATE INCREASES AND/OR BENEFIT CHANGES

TRUE

FOR-PROFIT COMMERCIAL PLANS HAVE THE RIGHT TO CANCEL A POLICY AT RENEWAL TIME IF THE PATIENT IS A HIGH USER OF BENEFITS

FALSE

BCBS PLANS DO NOT HAVE TO GUARANTEE THE TRANSFER OF MEMBERSHIP FROM GROUP PLAN TO INDIVIDUAL WHEN THE POLICYHOLDER MOVES INTO AN AREA SERVED BY DIFFERENT BCBS CORPORATION

TRUE

A PARTICIPATING PROVIDER AGREES TO WRITE OFF THE DIFFERENCE OR BALANCE BETWEEN THE AMOUNT CHARGED BY THE PROVIDER AND THE APPROVED FEE ESTABLISHED BY THE INSURER

TRUE

BCBS CORPORATIONS CONDUCT REGULAR TRAINING SESSIONS FOR PAR BILLING STAFF

TRUE

THE PREFERRED PROVIDER NETWORK (PPN) IS A PROGRAM THAT REQUIRES PROVIDERS TO ADHERE TO MANAGED CARE PROVISIONS

FALSE

A PATIENT CANNOT BE ASKED TO PAY A NON-PAR IN FULL ON THE DAY OF SERVICE

TRUE

BCBS FEE-FOR-SERVICE IS ALSO KNOWN AS TRADITIONAL COVERAGE

TRUE

RIDERS ARE SPECIAL CLAUSES STIPULATING ADDITIONAL COVERAGE OVER AND ABOVE THE STANDARD CONTRACT

FALSE

CONDITIONS SUCH AS "ACUTE RESPIRATORY INFECTION" OR "BLADDER INFECTION" ARE CONSIDERED MEDICAL EMERGENCY DIAGNOSES

FALSE

THE OUTPATIENT PRETREATMENT AUTHORIZATION PLAN REQUIRES PREAUTHORIZATION OF OUTPATIENT AMBULATORY SURGICAL CARE

FALSE

THE MANDATORY SECOND SURGICAL OPINION REQUIREMENT IS NECESSARY WHEN A PATIENT IS ADMITTED FOR SURGERY THROUGH THE EMERGENCY DEPARTMENT

ALL OF THE ABOVE

BLUE CROSS BLUE SHIELD COVERAGE INCLUDES THE FOLLOWING PROGRAMS _________
A) FEE-FOR-SERVICE
B) MANAGED CARE PLANS
C) MEDICARE SUPPLEMENTAL PLANS
D) ALL OF THE ABOVE

AN HMO

AN EXCLUSIVE PROVIDER ORGANIZATION (EPO) IS SIMILAR TO_________
A) MEDICARE
B) AN HMO
C) A PAR
D) NONE OF THE ABOVE

ALL OF THE ABOVE

A PCP IS A_________
A) PRIMARY CARE PROVIDER
B) PERSONAL CARE PHYSICIAN
C) PERSONAL CARE PROVIDER
D) ALL OF THE ABOVE

100% OF NONSURGICAL CARE RENDERED WITH 24-72 HOURS

A SPECIAL ACCIDENTAL INJURY RIDER COVERS __________
A) 100% OF SURGICAL CARE RENDERED WITHIN 24-72 HOURS
B) 80% OF SURGICAL CARE RENDERED WITHIN 24-72 HOURS
C) 100% OF NONSURGICAL CARE RENDERED WITHIN 24-72 HOURS
D) 80% OF NONSURGICAL CARE RENDERED WITHIN 24-72 HOURS

ALLOWS SUBSCRIBERS TO CHOOSE BETWEEN A NETWORK PROVIDER OR OUT-OF-NETWORK PROVIDER

A POINT OF SERVICE PLAN (POS)_______
A) ALLOWS SUBSCRIBERS TO CHOOSE BETWEEN A NETWORK PROVIDER OR OUT-OF-NETWORK PROVIDER
B) REQUIRES SUBSCRIBERS TO CHOOSE A NETWORK PROVIDER
C) REQUIRES SUBSCRIBERS TO CHOOSE AN OUT-OF-OF NETWORK PROVIDER
D) NONE OF THE ABOVE

A SUBSCRIBER-DRIVEN PROGRAM

THE BCBS PPO PLAN IS_____
A) A CAPITATED PROGRAM
B) A FEE-FOR-SERVICE PROGRAM
C) A SUBSCRIBER-DRIVEN PROGRAM
D) A NONCAPITATED PROGRAM

R

THE FEDERAL EMPLOYEE HEALTH BENEFITS PROGRAM CARDS CONTAIN THE PHRASE GOVERNMENT WIDE SERVICE BENEFIT PLAN AND EMPLOYEES HAVE IDENTIFICATION NUMBERS THAT BEGIN WITH THE LETTER______
A) G
B) F
C) S
D) R

ALLOWS MEMBERS TO HAVE ACCESS TO BENEFITS THROUGHOUT THE UNITED STATES AND WORLD

HEALTHCARE ANYWHERE______
A) ALLOWS MEMBERS TO RECEIVE HEALTH CARE THROUGHOUT THE UNITED STATES
B) ALLOWS MEMBERS TO RECEIVE HEALTH CARE FROM ANY PARTICIPATING PROVIDER
C) ALLOWS MEMBERS TO HAVE ACCESS TO BENEFITS THROUGHOUT THE UNITED STATES AND WORLD
D) ALLOWS MEMBERS TO RECEIVE HEALTH CARE FROM ANY NONPARTICIPATING PROVIDER

EMPLOYEES AND DEPENDENTS WHO SPEND MORE THAN SIX MONTHS OUTSIDE THE U.S.

BLUEWORLDWIDE EXPAT PROVIDES MEDICAL COVERAGE FOR______
A) EMPLOYEES AND DEPENDENTS WHO SPEND MORE THAN SIX MONTHS OUTSIDE THE U.S.
B) EMPLOYEES WHO ARE NOT U.S. CITIZENS
C) EMPLOYEES WITH DISABILITIES
D) SINGLE EMPLOYEES WITH NO DEPENDENTS

20% - 25%

THE MOST COMMON COINSURANCE AMOUNTS RANGE FROM ________
A) 10% - 20%
B) 20% - 35%
C) 20% - 25%
D) 20% - 50%

BOTH B AND C

WHEN A PATIENT IS COVERED BY PRIMARY AND SECONDARY OR SUPPLEMENTAL BLUE CROSS BLUE SHIELD HEALTH INSURANCE PLANS ________
A) THE PROVIDER MUST SEND A SEPARATE CLAIM TO EACH ONE
B) NO CLAIM IS NEEDED FOR THE SECONDARY OR SUPPLEMENTAL CLAIM
C) MODIFICATIONS ARE MADE TO THE CMS-1500 CLAIM
D) BOTH B AND C

HOSPITAL BILLS

BLUE CROSS PLAN WERE INITIATED IN 1929 AND ORIGINALLY PROVIDED COVERAGE FOR _______
A) OUTPATIENT BILLS
B) PHYSICIAN BILLS
C) HOSPITAL BILLS
D) AMBULATORY SURGICAL CENTER BILLS

PHYSICIAN SERVICES

BLUE SHIELD WAS CREATED IN 1938 AND ORIGINALLY COVERED ________
A) PHYSICIAN SERVICES
B) HOSPITAL SERVICES
C) AMBULATORY SURGICAL CENTER SERVICES
D) PHARMACY SERVICES

A REMITTANCE ADVICE

WHICH OF THE FOLLOWING IS ATTACHED WHEN COMPLETING SECONDARY CLAIMS ________?
A) AN EXPLANATION OF BENEFITS
B) A PAST DUE INVOICE
C) A REMITTANCE ADVICE
D) NONE OF THE ADVICE

ONE YEAR FROM DATE OF SERVICE

THE DEADLINE FOR FILING BLUE CROSS BLUE SHIELD CLAIMS IS _______
A) 30 DAYS FROM DATE OF SERVICE
B) ONE YEAR FROM DATE OF SERVICE
C) 60 DAYS FROM DATE OF SERVICE
D) 6 MONTHS FROM DATE OF SERVICE

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