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5 Written questions

5 Matching questions

  1. Pre-admission review:
  2. SOAP stands for:
  3. Managed Care Organizations (MCO):
  4. Current Procedural Terminology (CPT) is developed:
  5. Clinical Laboratory Improvement Act (CLIA):
  1. a review for medical necessity of inpatient care prior to admission
  2. b is responsible for the health of a group of enrollees & can be a health plan.
  3. c by American Medical Association in 1966
  4. d Established quality standards for all laboratory testing to ensure the accuracy, reliability, and timelines of patient test results regardless of where the test was performed.
  5. e S-Subjective

5 Multiple choice questions

  1. grants prior approval for reimbursement of a healthcare service
  2. 1860 by The Franklin Health Assurance Company of Massachusetts was the first commercial insurance company in the US to provide private healthcare coverage for injuries not resulting in death.
  3. amount for which the patient is financially responsible before insurance policy provides coverage
  4. responsible for providing healthcare services to subscribers in a given geographical area for a fixed fee.
  5. network of physicians & hospitals that have joined together to contract w/insurance companies, employers.

5 True/False questions

  1. Integrated Delivery System (IDS):organization of affiliated providers' sites that offer joint healthcare services to subscribers


  2. Utilization review:method of controlled healthcare cost & quality of care by reviewing the appropriateness & necessity of care provided to patients prior administration of case


  3. Coinsurance:provision in an insurance policy that requires the policy holder or patient to pay a specified dollar amount to a healthcare provider for each visit or medical service received


  4. What year First Blue Cross policy started:1939


  5. Health Maintenance Organization came in effect in1973