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5 Written questions

5 Matching questions

  1. HIPPA defines "abuse" as:
  2. The most common forms of "fraud" include:
  3. The difference between "fraud" & "abuse" is:
  4. Which was the first commercial insurance company in the US to provide private healthcare coverage for injuries not resulting in death?
  5. The percentage of costs a patient shares w/the health plan is called__?
  1. a involves actions that are inconsistent w/accepted, sound medical, costs to the program through improper payments
  2. b the individual's intent
  3. c Coinsurance
  4. d -billing for services not furnished
    -misrepresenting the diagnosis to justify payment
    -soliciting, offering, or receiving a kickback
    -unbunding codes
    -falsifying certificates of medical necessity, plans of treatment, & medical records to justify payment
  5. e Franklin Health Assurance Company

5 Multiple choice questions

  1. -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
  2. Medicare
  3. Diagnosis-related groups
  4. replace fee-for-service plans with affordable, quality care to healthcare consumers
  5. standards

5 True/False questions

  1. The primary intent of HIPPA legislation is to__replace fee-for-service plans with affordable, quality care to healthcare consumers


  2. The Hill-Burton Act provided federal grants for modernizing hospitals that had become obsolete because of a lack of capital investment during the Great Depression & WWII (1929 to 1945). IN return for federal funds.facilities were required to provide services free or at reduced rates to patients unable to pay for care


  3. Examples of "abuse" include:-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. A __ is responsible for supervising & coordinating healthcare services for enrollees:enrollees


  5. The problem-oriented record (POR) includes the following four components:database, problem list, initial plan, progress notes