week 6

Created by tseeley 

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hemorrhoids

a mass of unnaturally distended veins in the anal canal that lie just inside or outside the rectum

diabetes mellitus

a disorder of carbohydrate metabolizm that is characherized by high concentrations of sugar in the blood results from insufficient production or utilization of insulin

gastroscopy

examination of the stomach with an endoscope

hypoglycemia

abnormally low blood sugar is called

hiatal hernia

type of a gastrocele

anorexia

loss of appetite for food

appendectomy

excision of the vermiform appendix

kidney

what does the term Renal pertain to

hematura

blood in the urine is called

nephrotoxic

a term that means destructive to the kidney tissue

polyp

a tumor found on musosal surface such as the inner lining of the bladder

urinary incontinence

inability to hold urine in the bladder

urinary retention

inability to empty the bladder

nephrosonography

using ultrasound to study the kidney

dialysis

filtering blood to maintain proper balance

true

the health maintenance organization act of 1973 required most employers to offer HMO coverage to their employees as an alternative to traditional health insurance

false

medicare-eligible patients are not involved with HMO's or prepaid health plans

false

exclusive provider organizations (EPO's) are regulated by the federal government

true

in a point of service (POS) program members may choose to use a nonprogram provider at any time.

true

the term "turfing" means to transfer the sickest high-cost patients to other physiciansso that the provider appears as a low utilizer

true

if a primary care physician sends a patient to a specialist for consultation and the specialist is not in the managed care plan, the specialist may bill the primary care physician for the payment

true

in certain managed care plans there is an incentive for the gatekeeper to limit patient referrals to specialists

false

manage care plans allow laboratory tests to be performed at any facility the patient chooses

false

managed care plans never require a CMS-1500 claim form to be completed and submitted

true

usually there are no deductibles for managed care plans

true

copayment in a managed care plan is usually a fixed dollar amount (predetermined fee)

health maintenance organization act of 1973

a significant contribution to HMO development was the

capitation

when an HMO is paid a fixed amount for each patient served without considering the actual number or nature of services provided to each person is known as

not employees and are not paid salaries

in an independent practice association (IPA) physicians are

PPO preferred provider organization

an organization the gives members freedom of choice among physicians and hospitals and provides a higher level of benefits if the providers listed on the plan are used is called

POS point of service plan

a program that offers a combination of HMO-style cost management and PPO-style freedom of choice is

managed care organization

the abbreviation MCO stands for

utilization review

UR is the abbreviation for

prior approval

when a managed care plan requires a primary care physician to seek approval before referring a patient to a specialist, it is called obtaining

with hold

when a certain percentage of the monthly capitation payment is held out of the premium fund to pay for operating an IPA, it is known as

true

meidcare provides insurance for disabled individuals if they have received social security disability benefits for 24 months

false

all persons age 65 who meet eligibility requirements for medicare receive medicare part B (outpatient coverage)

true

medicare provides insurance for disabled workers of any age

true

patients who elect medicare part B coverage pay annually increasing basic premium payments

true

it is possible for an alien to be eligible for medicare part A and part B

true

employee and employer contributions help pay for medicare part A health services

false

medicare part A is called supplementay medical insurance (SMI)

false

in the medicare program, a physical examination is a covered benefit when performed within 12 months of enrollment

false

when a medicare recipient chooses a medicare senior plan he or she forfeits the medicare card

false

once a patient changes from medicare to a senior HMO, the patient must stay with that HMO for the remainder of the calendar year.

false

when a CMS-1500 claim for is automatically transferred by medicare to a medigap carrier, there is not need to obtain a spearate signature authorization for the medigap carrier

true

the assignment on a patient with medicare-medicaid must always be accepted or medicad will not pick up the residual

true

medicare transmits medigap claims electronically for participating physicians when medigap information is provided on the original medicare claim

the centers for medicare and medicaid services

medicare part A is run by

federal health insurance program

medicare is a

widow

the letter "D" following the identification number on the patients medicare card indicates

railroad retiree

the letters preceding the number on the patients medicare identification card indicate wage earner, husbands number, widow, and disabled adult

80% of the medicare approved charge

a participating physician with the medicare plan agrees to accept

time limit for submitting a medicare claim is

the end of the calendar year following the fiscal year in which services were performed

referral claim

when a medicare carrier transmits a medigap claim electronically to the medigap carrier, it is referred to as

part B

medicare outpatient coverage is referred to as

$10,000 for each item of service

the civil monetary penalties law carries a sanction for a penalty of up to

national provider identifier

a NPI number issued to a provider by CMS is the acronym for

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