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Chapter 2 Insurance

Question	Answer
Which is the abbreviation for the standardized notice that informs Medicare patients they are an outpatient receiving observation services and are not an inpatient of a hospital or a critical access hospital (CAH)?	MOON
Which legislation provides civilian employees of the federal government with medical care, survivors' benefits, and compensation for lost wages?	Federal Employees' Compensation Act
The first Blue Cross policy was introduced by	Baylor University in Dallas, Texas.
The Blue Shield concept grew out of the lumber and mining camps of the _____ region at the turn of the century.	Pacific Northwest
Health care coverage offered by _____ is called group health insurance.	employers
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 and World War II (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.
Third-party administrators (TPAs) administer health care plans and process claims, serving as a	system of checks and balances for labor and management.
Major medical insurance provides coverage for _____ illnesses and injuries, incorporating large deductibles and lifetime maximum amounts.	catastrophic or prolonged
The government health plan that provides health care services to Americans over the age of 65 is called	Medicare.
The percentage of costs a patient shares with the health plan (e.g., plan pays 80 percent of costs and patient pays 20 percent) is called	coinsurance.
The Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) enacted the _____ prospective payment system (PPS).	diagnosis-related groups
The Clinical Laboratory Improvement Act (CLIA) established quality standards for all laboratory testing to ensure the accuracy, reliability, and timeliness of patient test results	regardless of where the test was performed.
The National Correct Coding Initiative (NCCI) promotes national correct coding methodologies and eliminates improper coding. NCCI edits are developed based on coding conventions defined in _____	CPT
The intent of HIPAA legislation is to	Create better access to health insurance, limit fraud and abuse, and reduce administrative costs.
The Patient Protection and Affordable Care Act (PPACA) was signed into federal law by President Obama on March 23, 2010, and resulted in creation of a(n)_____.	Health insurance marketplace
Which is a primary purpose of the patient record?	ensure continuity of care
The problem-oriented record (POR) includes the following four components:	database, problem list, initial plan, progress notes
The electronic health record (EHR) allows patient information to be created at different locations according to a unique patient identifier or identification number, which is called	Record linkage.
When a patient states, "I haven't been able to sleep for weeks," the provider who uses the SOAP format documents that statement in the _____ portion of the clinic note.	Subjective
The provider who uses the SOAP format documents the physical examination in the _____ portion of the clinic note.	Objective
Civilian health and medical care program of the Department of Veterans Affairs (CHAMPVA)	Program that provides health benefits for veterans who are disabled, died, or died on duty within 30 days of active duty
CMS - 1500 claim	Claim submitted for reimbursement of physician office procedures and services
Coinsurance	the percentage the patient pays for covered services after the deductible has been met and the copayment has been paid
Continuity of Care	Documenting patient care services so that others who treat the patient have a source of information on which to base additional care and treatment
Deductible	Amount for which the patient is financially responsible before an insurance policy provides coverage
Copayment	provision in an insurance policy that requires the policyholder or the patient to pay a specified dollar amount to a healthcare provider for each visit or medical service received.
Electronic Health Record (EHR)	Global concept that includes the collection of patient in formation documented by a number of providers at different facilities regarding one patient
Fee Schedule	list of predetermined payments for health care services provided to patients
Group Health insurance	Traditional health care coverage by employers and other organizations
HIPAA	Mandates regulations that govern privacy, security, and electronic transactions standards for health care information
Medicaid	Health insurance for low-income Americans
National Correct Coding Initiative (NCCI)	Developed by CMS to promote national correct coding methodologies and to eliminate improper coding practices
Personal Health Record (PHR)	web-based application that allows individuals to manage and maintain their health information, in private, secure, and confidential environment
policyholder	person who signs contract with health insurance company and owns the health insurance policy
public health insurance	federal and state government health programs (Medicare, Medicaid, TRICARE)
Third party payer	health insurance company that provides coverage such as blue cross blue shield
World Health Organization (WHO)	developed the international classification of diseases (ICD)

Created by: vlw2861

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