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5 Written questions

5 Matching questions

  1. The Blue Shield concept grew out of the lumber & mining camps of the ___ region at the turn of the century?
  2. The difference between "fraud" & "abuse" is:
  3. The first Blue Cross policy was introduced by?
  4. HIPPA includes:
  5. The government health plan that provides healthcare services to Americans over the age of 65 is called ___?
  1. a -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
  2. b Baylor University in Dallas, Texas
  3. c Pacific Northwest
  4. d Medicare
  5. e the individual's intent

5 Multiple choice questions

  1. -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
  2. create better access to health insurance, limit fraud & abuse, and reduce administrative costs.
  3. replace fee-for-service plans with affordable, quality care to healthcare consumers
  4. Diagnosis-related groups
  5. System of checks & balance for labor & management

5 True/False questions

  1. 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


  2. Examples of "abuse" include:-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


  3. Healthcare coverage offered by ___ is called group health insurance.employers


  4. Which was the first commercial insurance company in the US to provide private healthcare coverage for injuries not resulting in death?ensure continuity of care


  5. Which is a primary purpose of the patient record?ensure continuity of care


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