5 Written questions
5 Matching questions
- The percentage of costs a patient shares w/the health plan is called__?
- Which is a primary purpose of the patient record?
- Whick term best describes those who receive managed healthcare plan services?
- The first Blue Cross policy was introduced by?
- Third-party administrators (TPAs) administer healthcare plans & process claims, serving as a ___?
- a Baylor University in Dallas, Texas
- b enrollees
- c System of checks & balance for labor & management
- d Coinsurance
- e ensure continuity of care
5 Multiple choice questions
- facilities were required to provide services free or at reduced rates to patients unable to pay for care
- Regardless of where the test was performed
- Pacific Northwest
- involves actions that are inconsistent w/accepted, sound medical, costs to the program through improper payments
- -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
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
The primary intent of HIPPA legislation is to__ → replace fee-for-service plans with affordable, quality care to healthcare consumers
HIPPA defines "fraud" as: → involves actions that are inconsistent w/accepted, sound medical, costs to the program through improper payments
A nonprofit organization that contracts w/& acquires the clinical and business assets of phyician practices is called a: → Medicare
The most common forms of "fraud" include: → -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