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AHS 110 Mid term
Terms in this set (87)
Which would be indicative of a PPO?
If the patient chooses a provider who is not preferred, those services are provided at a higher rate.
An EOB is an invoice (a bill) for charges from the provider.
A primary care (general practitioner) physician sees a patient in her office for symptoms of cough and chest congestion. The medical coder in the office sends a claim to the patient's insurance company. The medical coder used which of the following to code for this service?
Charlie's recent physician office visit was not paid at all by the insurance company. It was his first claim of the year. The claim totaled $200. The reason the claim was denied was likely related to Charlie's:
Provide an example of a service that is commonly pointed out as "not covered" in a health insurance plan, but that an insured person might wonder if it is covered.
Each year an insured person needs to decide what set of benefits or insurance plan to go with for the next year. This range of time in which to decide is called the:
ICD-9-CM is used for billing the payer for procedures performed in hospitals and
a. Can be a PPO
b. Shifts the risk of loss to the provider
c. Can be an HMO
Correct d. All of the above
In general, the larger the risk pool for a heath insurance plan the:
Lower the premium
The majority of low income families that do not have health insurance have at least one working family member
Mya Kamiri is a retiree from General Motors and has a health plan from GM that carries on after her retirement. She is over age 65 and is, and as a result, automatically qualified for Medicare. Mya signs up for Medicare in addition to her GM plan. What must be in place in order for claims to be processed correctly and in the right order?
Coordination of benefits clause
The copayment is the:
Portion of the services paid by the patient at point of service
An "insurance policy" is an agreement negotiated between an individual patient and a provider of health services as to how much the provider is going to charge for services.
The only way to get health insurance is through an employer.
Which if the following is not a type of health insurance plan?
Health Common Procedures Coding System
In some HMO's physicians' salaries are paid through the HMO
A deductible is the
Amount paid by the patient before the third-party payer begins to pay
Premiums are the
Negotiated payment for coverage between the payer and the provider
In order to calculate risks and help an insurance company figure out if the organization can make money from insuring various risk pools and/or individuals the insurance company will hire:
All employers must provide health insurance
What percent of Americans do not have health insurance?
Max Shapiro's health care insurance company informed him that he must pay the bill from the provider first and then the insurance company will reimburse him. Max is paying for what type of health insurance?
Indemnity health insurance.
Which is an example of "organizing" in the duties of management?
b. Efficient use and throughput of supplies.
Which is an example of "controlling" in the duties of management?
Restructuring departmental employee positions.
All of the following are types of health care facilities except
haring hazards or consequences in a partnership might be an advantage, but on the other hand each partner must also share all the ____________ as
One key way hospitals try to improve the chances for appropriate payment from all health insurers is to
Become TJC accredited
Which is an example of "planning" in the duties of management?
Strategic forecasting, setting objectives, setting goals
The necessity for a health care organization to obtain a Certificate of Need is an example of the government being a:
Regulator of health care providers
The instructor shared information about a CAH funding available for some hospitals. This funding is
Comes from the federal government for states to distribute through grants
Ambulatory care services treat admitted inpatients.
A not-for-profit hospital is described by all of the following except:
Has the goal of making money above expenses
There is always a trade off in various structures within a business. For sole proprietorship it can be viewed as an advantage to be able to make all the decisions, but sole proprietors take on all the ___________.
The primary purpose of the Patient Protection and Affordable Care Act was to expand access to insurance coverage.
Risk is limited to the investor's original up front money put into the business in this type of structure.
The Joint Commission is operated by the federal government.
As demand for products or services go up then prices go
An increase in price level at any given time is
Which was enacted to provide for smoother transition or continuity between health insurance plans for patients
The unemployment rate is a factor considered by health care administrators when making decisions for the organization
A hospital conducting business comparisons to other hospitals is comparing
To the industry
The government will often reduce interest rates and cut taxes to stimulate spending during the:
Tracks the flow of money in and out of a business
Primary care physicians primarily see patients for preventive care
Nursing professionals comprise the largest health occupation.
The salaries of LPNs and RNs are comparable
All states require physician assistants to pass a national certifying examination
Dental assistants do the bulk of health assessment, x-rays, and teeth cleaning.
Physician assistants may prescribe medications
Understanding the musculoskeletal system and employing a holistic approach describes:
To practice medicine, in most states, a physician must complete all of the following EXCEPT:
serve as a health aide
Fighting disease using proven, traditional treatment modalities is:
Among the lists provided, choose the correct answer that ranks the primary place of employment for physicians, the secondary, and finally the area least likely.
group practice (most), hospitals (secondary), and solo practice (least)
Gastroenterologist specialize in the diagnosis and treatment of:
disease and disorders of the stomach and intestine
All of the following are concerns in the health care industry except:
oversupply of physicians
Among this list, the health professional responsible for planning patient care is the:
Out of the five stages of the nursing process which one is the third stage or step?
The National Registry of Emergency Medical Technicians (NREMT) has four levels of service providers. Out of the provided answers below which denotes the higher skill level for these emergency workers?
Typical schooling for a chiropractor is
4 years at a school specific to chiropractic training and education
The organizations that employ most of the medical imaging technologists are:
Which profession focuses on improving patients' ability to perform daily living and work skills.
Which of the following occupations prepare tissue samples for the pathologist to view?
There is a certain medical code for a chest x-ray that is performed on a patient. This code is provided to the insurance company for billing. Under which guideline would one look for this billing code?
Out of all the health professions below, which is the fastest growing in terms of new jobs?
Your instructor went over the fact that fewer physicians work in and own their own "solo" practice or private group practice. In lecture we summed up the reason for this in one word (which begins with an "s").
What is that one word used to describe the main or overarching reason for most physicians to move out of solo practice or private group practices? (one word, all lower case please)
A professional who performs testing services. A _______________ (1 word) usually has more training than a technician. (one word, all lower case please)
Physicians order a variety of "______________ tests"
Radiation therapists do not image the body, but rather use radiation to treat and kill ________ cells and tumors.
According to our text the type of facilities or organizations with the greatest number of jobs in health care are physician offices
The wellness model is a viewpoint about health that focuses on the treatment of disease.
The Flint, MI water crisis will mitigate the need for an epidemiological study to be conducted
In the two decades following 2010, millions of Americans will reach age 65. This concerns the health care industry because:
there will be an increased need for geriatric care
The study of disease in the population is:
All of the following are health care facilities except:
a. long-term care facility
d. physician offices
Health care policy addresses all of the following issues except:
The medical model includes all of the following except:
focus on disease prevention
focus on treatment
illness and disease require treatment
focus on diagnosis
The Centers for Disease Control and Prevention do all of the following except:
a. reported in 2009 that over 65% of the respondents rated their health as "very good" or "excellent."
Correctb. monitor hospital compliance with HIPAA
c. survey Americans about their health
d. collect health statistics
In 2009, the U.S. spent ______ on health care expenditures.
All of the following are examples of where long term care could take place except:
a. adult day care
d. rehabilitation centers
The intentions of the Patient Protection and Affordable Care Act:
seeks to improve health care performance
Managed care can be described by all of the following except:
a. manages the price paid for services
b. manages the patient's utilization of services
c. has the objective of only providing those services that are needed
Correctd. maintains a sustainable noncompetitive advantage
Which statement is accurate regarding organizational structure of these governmental agenices?
The U.S. Department of Labor is over the The U.S. Bureau of Labor Statistics
Your instructor gave you a specific organization to check to look into for your health career job outlook? It was ?...
. The U.S. Bureau of Labor Statistics
In comparision to teach other- which type of health insurance policy will a patient pay the most "out of pocket" if they go outside of their health service provider network.
Which statistial report did the instructor specifically speak of to check your chosen health career job outlook? (please spell correctly and use a capital letter to begin the word)
The __________________ Outoook Handbook
The abbreviation "LTC" stands for ___________ ___________ ____________.
long term care
Quality of care, access to care, and cost of care---- These are the _________ trade-offs that we must constantly work to balance in health care.
(please spell correctly and do not capitalize this word)
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