5 Written questions
5 Matching questions
- A nonprofit organization that contracts w/& acquires the clinical and business assets of phyician practices is called a:
- The percentage of costs a patient shares w/the health plan is called__?
- Established quality standards for all laboratory testing to ensure the accuracy, reliability, & timelines of patient test results.
- Healthcare coverage offered by ___ is called group health insurance.
- Which replaced the 1908 workers' compensation
legislation & provided civilian employees of the federal government w/medical car, survivors' benefits, & compensation for lost wages?
- a medical foundation
- b employers
- c Regardless of where the test was performed
- d Federal Employees' Compensation Act
- e Coinsurance
5 Multiple choice questions
- -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
- database, problem list, initial plan, progress notes
- Diagnosis-related groups
- ensure continuity of care
5 True/False questions
Major medical insurance provides coverage for ___ illnesses & injuries, incorporating large deductibles & lifetime maximum amounts. → ensure continuity of care
The difference between "fraud" & "abuse" is: → the individual's intent
The Blue Shield concept grew out of the lumber & mining camps of the ___ region at the turn of the century? → create better access to health insurance, limit fraud & abuse, and reduce administrative costs.
HIPPA defines "abuse" as: → involves actions that are inconsistent w/accepted, sound medical, costs to the program through improper payments
The first Blue Cross policy was introduced by? → replace fee-for-service plans with affordable, quality care to healthcare consumers