5 Written questions
5 Matching questions
- The first Blue Cross policy was introduced by?
- 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 ___?
- Which was the first commercial insurance company in the US to provide private healthcare coverage for injuries not resulting in death?
- Examples of "abuse" include:
- a System of checks & balance for labor & management
- b -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
- c Franklin Health Assurance Company
- d Federal Employees' Compensation Act
- e Baylor University in Dallas, Texas
5 Multiple choice questions
- create better access to health insurance, limit fraud & abuse, and reduce administrative costs.
- Diagnosis-related groups
- -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
- medical foundation
5 True/False questions
The problem-oriented record (POR) includes the following four components: → database, problem list, initial plan, progress notes
The difference between "fraud" & "abuse" is: → the individual's intent
HIPPA defines "abuse" as: → an intentional deception misrepresentation that someone makes, knowing it is false, that could result inan unauthorized payment
Healthcare coverage offered by ___ is called group health insurance. → 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