← Health Insurance Test
5 Written Questions
5 Matching Questions
- First Blue Cross policy:
- What year Blue Shield started:
- Concurrent review:
- a prospective payment system that reimburses hospitals for impatient stays
- b review for medical necessity of tests/procedures ordered during inpatient hospitalization
- c introduced a plan to guarantee school teachers 21 days of hospital care for 46 a year.
- d person in whose name the insurance policy is issued
- e 1939
5 Multiple Choice Questions
- provider accepts preestablished payments for providing healthcare services to enrollness over a period of time (usually one year)
- 1860 by The Franklin Health Assurance Company of Massachusetts was the first commercial insurance company in the US to provide private healthcare coverage for injuries not resulting in death.
- network of physicians & hospitals that have joined together to contract w/insurance companies, employers.
- which describes patient encounters with provides for the purpose of evaluation & management of general health status.
- HCFA (now called CMS) required providers to use the HCFA-1500 (now called the CMS-1500) to submit Medicare claims
5 True/False Questions
Point-of-Service Plan (POS): → reimbursement methodology that increases payment if the healthcare service fees increase, if multiple units of service are provided, or if more expensive services are provided instead of less expensive services
Utilization review: → review for medical necessity of inpatient care prior to admission
Preauthorization: → prior approval
Major medical: → coverage for catastrophic or prolonged illness & injuries
Integrated Delivery System (IDS): → organization of affiliated providers' sites that offer joint healthcare services to subscribers