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5 Written questions

5 Matching questions

  1. A nonprofit organization that contracts w/& acquires the clinical and business assets of phyician practices is called a:
  2. The percentage of costs a patient shares w/the health plan is called__?
  3. Established quality standards for all laboratory testing to ensure the accuracy, reliability, & timelines of patient test results.
  4. Healthcare coverage offered by ___ is called group health insurance.
  5. Which replaced the 1908 workers' compensation
    legislation & provided civilian employees of the federal government w/medical car, survivors' benefits, & compensation for lost wages?
  1. a medical foundation
  2. b employers
  3. c Regardless of where the test was performed
  4. d Federal Employees' Compensation Act
  5. e Coinsurance

5 Multiple choice questions

  1. -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
  2. database, problem list, initial plan, progress notes
  3. Diagnosis-related groups
  4. enrollees
  5. ensure continuity of care

5 True/False questions

  1. Major medical insurance provides coverage for ___ illnesses & injuries, incorporating large deductibles & lifetime maximum amounts.ensure continuity of care


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


  3. 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.


  4. HIPPA defines "abuse" as:involves actions that are inconsistent w/accepted, sound medical, costs to the program through improper payments


  5. The first Blue Cross policy was introduced by?replace fee-for-service plans with affordable, quality care to healthcare consumers