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Health Insurance
Test Chpt 12-17
| Question | Answer |
|---|---|
| Which type of health insurance covers the medical expenses of individuals (e.g. private health insurance) and groups (e.g. employer group health insurance)? | commercial |
| Which is traditional fee-for-service health insurance that covers a portion of services, such as inpatient hospitalizations or physician office visits, with the patient paying the remaining costs? | indemnity insurance |
| Which includes health maintenance organizations and preferred provider organizations? | Managed care |
| Group health insurance is available through employers and other organizations, and all or part of the premium costs are paid by employers. Employer-based group health insurance ____________ | covers all employees, regardless of health status, and cannot be canceled if an employee becomes ill |
| Which type of insurance is defined as reimbursement for income lost as a result of a temporary or permanent illness or injury? | disability |
| Which refers to the contractual right of a third-party payer to recover health care expenses from a liable party? | subrogation |
| If a patient is covered by two different policies, the usual procedure for submitting a claim would be__________. | to submit to the primary payer first, followed by submitting to the second part after primary payment is received |
| Nonprofit corporations are charitable, educational, civic, or humanitarian organizations whose profits are __________. | returned to the nonprofit corporation |
| For -profit corporations pay taxes on profits generated by the corporation's enterprises and pay dividends to _______on after -tax profits. | shareholders |
| BCBS fee-for-service ___________________ coverage includes additional benefits, such as office visits, physical and occupational therapy, and mental health encounters. | major medical |
| BCBS fee-for-service _________ coverage includes minimum benefits, such as inpatient hospitalizations and diagnostic laboratory services. | basic |
| The BlueCross BlueShield Federal Employee Program (FEP) is a(n)__________ health benefits program estaablished by an Act of Congress in 1959. | employer-sponsored |
| BCBS corporation offer several federally designed and regulated Medicare supplemental plans that augment the Medicare program by paying for Medicare deductibles and copayments. These plans are usually identified by ___ on the patient's plan ID card. | Medigap |
| Which program pays for inpatient hospital critical care access, skilled nursing facility stays, hospice care, and some home health care? | Medicare Part A |
| Which program pays for physician services, outpatient hospital care, and durable medical equipment? | Medicare Part B |
| Which program includes managed care and private fee-for-service plans that provide contracted care to Medicare patients? | Medicare Part C |
| Which program added prescription medication coverage to the original Medicare plan, some Medicare cost plans, some Medicare private fee-for-service plans, and Medicare medical Savings Account Plans? | Medicare Part D |
| Which insurance claim is submitted to receive reimbursements under Medicare Part A? | UB-04 |
| Which insurance claim is submitted to receive reimbursement under Medicare Part B? | CMS-1500 |
| Which insurance claim is submitted to receive reimbursement under Medicare Part C? | CMS-1500 or UB-04 |
| Medicare beneficiaries can also obtain supplemental insurance to help cover costs not reimbursed by the original Medicare plan. This type of coverage is called ____________. | Medigap |
| Individuals who wait until 65 to apply for Medicare will cause delay in the start of Pt B , because they will have to wait until next ___ enrollment period, held January 1 through March 31 of each year, with Pt B coverage starting on July 1 of that year. | General |
| A Medicare-Medicaid (Medi-Medi) crossover plan provides both Medicare and Medicaid coverage to _______ beneficiaries with low incomes. | Medicare |
| The federal name for the Title 19 medical assistance program is ________________. | Medicaid |
| Which is the current program that makes cash assistance available, for a limited time, for children deprived of support because of a patent's absence, death, incapacity, or unemployment? | Temporary Assistance for Needy Families |
| The State Children's Health Insurance Program (CHIP) was implemented in accordance with the Balanced Budget Act (BBA) to allow states to create or expand existing insurance programs, providing more federal funds to states for the purpose of expanding_____ | Medicaid |
| Any time patients state that they receive Medicaid, they must present a valid Medicaid identification card because eligibility, in many states, will depend on the patient"s ______________ income. | monthly |
| When the patient is covered by other medical or liablity policies, Medicaid reimburses providers_______________. | last |
| Any provider who accepts Medicaid patient must accept the Medicaid-determined payment as __________. | payment in full |
| Which allows providers to electronically access the state's eligibilty file to verify Medicaid eligibility? | MEVS |
| A mother/baby claim is submitted for services provided to a baby under the ______________ Medicaid identification number. | mother's |
| Which is a health care program for active duty members of the military and their qualified family members? | TRICARE |
| Which term is used to describe the Army, Navy, Air Force, Marines, and Coast Guard, Public Health Service Commissioned Corps, and the National Oceanic and Atmospheric Administration (NOAA) Commissioned Corps? | uniformed services |
| TRICARE ____________ are uniformed service personnel who are either active duty, retired, or deceased. | sponsors |
| When a patient seeks health care under the TRICARE program, sponsor information is verified in the ____________ computer system, which contains up-to-date workforce personnel information. | DEERS |
| Which is a comprehensive health care program for which the Department of Veterans Affairs shares costs of covered health care services and supplies with eligible beneficiaries? | CHAMPVA |
| Which is the TRICARE managed care options similar to civilian health maintenance organization? | TRICARE PRIME |
| The Occupational Safety and Health Act of 1970 created the Occupational Safety and Health Administration (OSHA) to protect employees against injuries from occupational hazards in the workplace. OSHA and its state partners (of approximately 2,100 inspector | standards |
| Temporary disability claims cover health care treatment for illness and injuries as well as payment for __________. | lost wages |
| Permanent disability refers to an ill or injured employee's _____________ capacity to return to work. | diminished |
| First Report of Injury forms are completed by the _____________ when treatment for a work-related illness or injury is sought. | physician or other healthcare provider |
Created by:
tbharris
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