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5 Written questions

5 Matching questions

  1. The first Blue Cross policy was introduced by?
  2. Which replaced the 1908 workers' compensation
    legislation & provided civilian employees of the federal government w/medical car, survivors' benefits, & compensation for lost wages?
  3. Third-party administrators (TPAs) administer healthcare plans & process claims, serving as a ___?
  4. Which was the first commercial insurance company in the US to provide private healthcare coverage for injuries not resulting in death?
  5. Examples of "abuse" include:
  1. a System of checks & balance for labor & management
  2. 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
  3. c Franklin Health Assurance Company
  4. d Federal Employees' Compensation Act
  5. e Baylor University in Dallas, Texas

5 Multiple choice questions

  1. create better access to health insurance, limit fraud & abuse, and reduce administrative costs.
  2. Diagnosis-related groups
  3. -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
  4. medical foundation
  5. standards

5 True/False questions

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


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


  3. HIPPA defines "abuse" as:an intentional deception misrepresentation that someone makes, knowing it is false, that could result inan unauthorized payment


  4. Healthcare coverage offered by ___ is called group health insurance.replace fee-for-service plans with affordable, quality care to healthcare consumers


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