5 Written questions
5 Matching questions
- The Blue Shield concept grew out of the lumber & mining camps of the ___ region at the turn of the century?
- The difference between "fraud" & "abuse" is:
- The first Blue Cross policy was introduced by?
- HIPPA includes:
- The government health plan that provides healthcare services to Americans over the age of 65 is called ___?
- 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
- b Baylor University in Dallas, Texas
- c Pacific Northwest
- d Medicare
- e the individual's intent
5 Multiple choice questions
- -billing for services not furnished
-misrepresenting the diagnosis to justify payment
-soliciting, offering, or receiving a kickback
-falsifying certificates of medical necessity, plans of treatment, & medical records to justify payment
- create better access to health insurance, limit fraud & abuse, and reduce administrative costs.
- replace fee-for-service plans with affordable, quality care to healthcare consumers
- Diagnosis-related groups
- System of checks & balance for labor & management
5 True/False questions
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
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
Healthcare coverage offered by ___ is called group health insurance. → employers
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
Which is a primary purpose of the patient record? → ensure continuity of care