5 Written questions
5 Matching questions
- The Blue Shield concept grew out of the lumber & mining camps of the ___ region at the turn of the century?
- The Tax Equity & Fiscal Responsibility Act of 1982 enacted the ___ prospective payment system (PPS).
- The government health plan that provides healthcare services to Americans over the age of 65 is called ___?
- Major medical insurance provides coverage for ___ illnesses & injuries, incorporating large deductibles & lifetime maximum amounts.
- Which was the first commercial insurance company in the US to provide private healthcare coverage for injuries not resulting in death?
- a Franklin Health Assurance Company
- b Pacific Northwest
- c catastrophic or prolonged
- d Diagnosis-related groups
- e Medicare
5 Multiple choice questions
- an intentional deception misrepresentation that someone makes, knowing it is false, that could result inan unauthorized payment
- -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
- Baylor University in Dallas, Texas
- Federal Employees' Compensation Act
5 True/False questions
The term that describes requirements created by accreditation organizations is ___. → standards
The intent of managed health care was to: → replace fee-for-service plans with affordable, quality care to healthcare consumers
A __ is responsible for supervising & coordinating healthcare services for enrollees: → primary care provider
The difference between "fraud" & "abuse" is: → the individual's intent
A nonprofit organization that contracts w/& acquires the clinical and business assets of phyician practices is called a: → Medicare