Insurance Today Ch 3

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Practice of Medicine is:

A Business

Primary goal of health insurance professional is

Complete & submit insurance claims, Conduct billing & collection procedures, to generate as much money for the practice as legally possible.

Malpractice lawsuite

A breach of medical care can result in:

The employer is ultimatley responsible for employee actions:

Loosley translated, the latin term respondeat superior means:


Failur to excercise a reasobale degrww of care is referred to as:

Legal Contracts

Health Insurance policy & the relationship between a healthcare proveder & a patient are considered:

Making an offer

In terms of a contract law, when an individual completes an application for health insurance, he or she is:

Completing an acceptance

When the insurance company agrees to grant health insurance coverage to an inividual, this is called:


The binding force in any contract that gives it legal status- the thing of value that each party gives to the other- is the:


For the contract to be enforceable, it must be:

Mentally competent

The parties to a legal contractual agreement must be:

Emancipated minors

Minors who are married or living separate and apart from their parents and not receiving any financial support from them:

Implied contract

The contract between a healthcare provider and a patient is referred to as:


Ceasing to provide care to a patient without following prudent steps is a breach of the physician/patient contract, referred to as:

Federal Privacy Act of 1974

The act that regulates disclosure of confidential information is the:

Federal Omnibus Budget Reconciliation Act of 1987 (OBRA)

The act of following current or former employees or dependants younger than age 65 to become eligible for Medicare because of end-stage renal disease is the:


Standards of human conduct - sometimes called morals - of a particular group or culture are commonly known as:


Following the rules and conventions governing correct or polite behavior in society is called:

Health Record

A clinical scientific, administrative, and legal documentation of facts containing information relating to a patient's care and treatment is called a:

Written Consent

A health record is considered priviledged communication; information in it should not be disclosed without a patient's:

Appropriate addendum

If additional needs to be added to a patients record, it should be in the form of a:

Adequate and complete documentation helps to:

Determine the levels of service; Establish medical neccesity; Justify the fees charged.

Lack of proper documentation often results in:

Denied claims; reduced claim benefits.

Insurance portability

HIPPA's objective stating that employees cannot be denied health insurance coverage when moving from one group health plan to another is called:

Incidental disclosure

If two people who know each other meet inadvertently in a physician's reception area, HIPPA refers to this exposure:

Timeliness, according to the Joint Commision, is within ______ hours of the encounter.


Situations that do not come under the umbrella of the patient confidentiality include:

Communicable disease; The patient is being treated as a result of an on-the-job injury

Subpoena duces tectum

A legal document that requires an individual to appear in court with a piece of evidence that can be used or inspected by the court is called:

A breach of confidentially

What results when confidential information is disclosed to a third party without patient consent or court order?

Health insurance professional should be ________ in the area of the medical law and liability.


Medical laws regulating insurance are _____ the same from state to state.


Direct and indirect patient contact involves ethical and legal _________.


In contract law, the promise to pay the premium is the ____________ of the individual seeking health insurance coverage


How long medical records are kept and stored and disposed of __________ from practices to practice and state to state.


A written release of information is not necessary to process an __________for a patient's healthcare information they collect, maintain, use and transmit eclectronically.

insurance claim

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