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5 Written questions

5 Matching questions

  1. The percentage of costs a patient shares w/the health plan is called__?
  2. Which is a primary purpose of the patient record?
  3. Whick term best describes those who receive managed healthcare plan services?
  4. The first Blue Cross policy was introduced by?
  5. Third-party administrators (TPAs) administer healthcare plans & process claims, serving as a ___?
  1. a Baylor University in Dallas, Texas
  2. b enrollees
  3. c System of checks & balance for labor & management
  4. d Coinsurance
  5. e ensure continuity of care

5 Multiple choice questions

  1. facilities were required to provide services free or at reduced rates to patients unable to pay for care
  2. Regardless of where the test was performed
  3. Pacific Northwest
  4. involves actions that are inconsistent w/accepted, sound medical, costs to the program through improper payments
  5. -excessive charges for services, equipment, or supplies
    -submitting claims for items or services that are not medically necessary to treat the patient's stated condition
    -improper billing practices that result in a payment by a government program when that claim is the legal responsibility of another third-party payer
    -voilations of participating provider agreements w/insurance companies

5 True/False questions

  1. Which was the first commercial insurance company in the US to provide private healthcare coverage for injuries not resulting in death?Franklin Health Assurance Company


  2. The primary intent of HIPPA legislation is to__replace fee-for-service plans with affordable, quality care to healthcare consumers


  3. HIPPA defines "fraud" as:involves actions that are inconsistent w/accepted, sound medical, costs to the program through improper payments


  4. A nonprofit organization that contracts w/& acquires the clinical and business assets of phyician practices is called a:Medicare


  5. The most common forms of "fraud" include:-billing for services not furnished
    -misrepresenting the diagnosis to justify payment
    -soliciting, offering, or receiving a kickback
    -unbunding codes
    -falsifying certificates of medical necessity, plans of treatment, & medical records to justify payment


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