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5 Written questions

5 Matching questions

  1. The most common forms of "fraud" include:
  2. The Blue Shield concept grew out of the lumber & mining camps of the ___ region at the turn of the century?
  3. HIPPA includes:
  4. Which replaced the 1908 workers' compensation
    legislation & provided civilian employees of the federal government w/medical car, survivors' benefits, & compensation for lost wages?
  5. Third-party administrators (TPAs) administer healthcare plans & process claims, serving as a ___?
  1. a Federal Employees' Compensation Act
  2. b -improve the portability & continuity of health insurance coverage in the group & individual markets
    -combat waste, fraud & abuse in health insurance & healthcare delivery
    -improve access to long-term care services & coverage
  3. c System of checks & balance for labor & management
  4. d -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
  5. e Pacific Northwest

5 Multiple choice questions

  1. Franklin Health Assurance Company
  2. replace fee-for-service plans with affordable, quality care to healthcare consumers
  3. medical foundation
  4. -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. the individual's intent

5 True/False questions

  1. Established quality standards for all laboratory testing to ensure the accuracy, reliability, & timelines of patient test results.Regardless of where the test was performed


  2. The primary intent of HIPPA legislation is to__create better access to health insurance, limit fraud & abuse, and reduce administrative costs.


  3. The Hill-Burton Act provided federal grants for modernizing hospitals that had become obsolete because of a lack of capital investment during the Great Depression & WWII (1929 to 1945). IN return for federal funds.facilities were required to provide services free or at reduced rates to patients unable to pay for care


  4. The first Blue Cross policy was introduced by?Baylor University in Dallas, Texas


  5. HIPPA defines "fraud" as:an intentional deception misrepresentation that someone makes, knowing it is false, that could result inan unauthorized payment


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