5 Written questions
5 Matching questions
- The most common forms of "fraud" include:
- The Blue Shield concept grew out of the lumber & mining camps of the ___ region at the turn of the century?
- HIPPA includes:
- Which replaced the 1908 workers' compensation
legislation & provided civilian employees of the federal government w/medical car, survivors' benefits, & compensation for lost wages?
- Third-party administrators (TPAs) administer healthcare plans & process claims, serving as a ___?
- a Federal Employees' Compensation Act
- 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
- c System of checks & balance for labor & management
- d -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
- e Pacific Northwest
5 Multiple choice questions
- Franklin Health Assurance Company
- replace fee-for-service plans with affordable, quality care to healthcare consumers
- medical foundation
- -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
- the individual's intent
5 True/False questions
Established quality standards for all laboratory testing to ensure the accuracy, reliability, & timelines of patient test results. → Regardless of where the test was performed
The primary intent of HIPPA legislation is to__ → create better access to health insurance, limit fraud & abuse, and reduce administrative costs.
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
The first Blue Cross policy was introduced by? → Baylor University in Dallas, Texas
HIPPA defines "fraud" as: → an intentional deception misrepresentation that someone makes, knowing it is false, that could result inan unauthorized payment