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5 Written questions

5 Matching questions

  1. The Blue Shield concept grew out of the lumber & mining camps of the ___ region at the turn of the century?
  2. The Tax Equity & Fiscal Responsibility Act of 1982 enacted the ___ prospective payment system (PPS).
  3. The government health plan that provides healthcare services to Americans over the age of 65 is called ___?
  4. Major medical insurance provides coverage for ___ illnesses & injuries, incorporating large deductibles & lifetime maximum amounts.
  5. Which was the first commercial insurance company in the US to provide private healthcare coverage for injuries not resulting in death?
  1. a Franklin Health Assurance Company
  2. b Pacific Northwest
  3. c catastrophic or prolonged
  4. d Diagnosis-related groups
  5. e Medicare

5 Multiple choice questions

  1. an intentional deception misrepresentation that someone makes, knowing it is false, that could result inan unauthorized payment
  2. Coinsurance
  3. -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
  4. Baylor University in Dallas, Texas
  5. Federal Employees' Compensation Act

5 True/False questions

  1. The term that describes requirements created by accreditation organizations is ___.standards


  2. The intent of managed health care was to:replace fee-for-service plans with affordable, quality care to healthcare consumers


  3. A __ is responsible for supervising & coordinating healthcare services for enrollees:primary care provider


  4. The difference between "fraud" & "abuse" is:the individual's intent


  5. A nonprofit organization that contracts w/& acquires the clinical and business assets of phyician practices is called a:Medicare