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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