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HIT 130 Quiz 2Review
| Question | Answer |
|---|---|
| A managed care contract is considered a legal document between the ________ and the ________. | provider, insurer |
| What term is used to identify a medical provider who is under contract with the MCO? | Participating provider |
| Which of the following items is not found in a managed care contract regarding provider 's compensation for services? | Appeal process for denied claims |
| What is the function of the National Committee for Quality Assurance (NCQA)? | To provide accreditation for MCOs |
| The Patient's Bill of Rights... | It is an ethical standard adopted by an advisory commission on healthcare consumer protection. |
| The contract issued by a payer under which a covered person may be entitled for healthcare services. | Benefit plan |
| The determination of which of two or more health benefit plans will provide health benefits for a cover person as a primary or secondary payer. | Coordination of benefits (COB) |
| The highest allowable fee payable by the payer for a contracted service | Fee maximum |
| Healthcare services provided to a covered person under the terms of the benefit plan. | Covered services |
| Services that are accepted by the healthcare profession as appropriate and effective for the condition being treated. | Medically necessary |
| A small, personalized medical practice that takes care of a limited number of patients under which the patients pay the provider an annual fee or retainer is called a(n) ________ contract. | concierge |
| Under HIPAA, the following are covered entities ... | Health insurance plans, clearing houses and healthcare providers |
| HIPAA guidelines apply to the following healthcare administrative transactions... | Health insurance claims, claim status requests and reports and eligibility requests and verifications |
| Which HIPAA standard requires the healthcare industry to use of medical codes (ICD-10, CPT-4, etc.) when submitting healthcare claims? | Uniform code sets |
| HIPAA privacy protections apply to which type of healthcare data? | paper and electronic records |
| A person who has a privacy complaint can file it with the: | DHHS Office for Civil Rights(OCR) |
| In the event of a security breach in regard to protected health information (PHI), providers and other covered entities must notify both the DHHS Office for Civil Rights (OCR) and the: | individuals whose records were affected. |
| Which type of safeguard involves the use of encryption when data is transmitted over open networks? | Technical |
| Under the HIPAA Privacy Rule, a physician may discuss a patient's medical condition or treatment with a family member or friend only if: | the patient agrees verbally, in writing, or consent is implied. |
| Otherwise known as a late effect | Sequela |
| An indication of a disorder or disease that the patient reports to the physician, but the physician cannot measure. | Symptom |
| A procedure or diagnosis name derived from the name of a person. | Eponym |
| A symptom related to the patient's condition. | Manifestation |
| The condition of being diseased. | Morbidity |
| The condition that requires the most resources and care is known as the __________ diagnosis. | primary |
| These are examples of primary purposes of ICD-10-CM Coding... | to provide a universal coding system for reporting of medical diagnoses, establish medical necessity, improve reporting of public health, forecast healthcare needs |
| The ______ Act of 2009 introduced the concept of meaningful use. | Health Information Technology for Economic and Clinical Health Act (HITECH) |
| ____________is the set of requirements regarding the implementation of standardized, certified, interoperable electronic health records. | meaningful use |
| _______ are groups of providers and healthcare facilities that provide evidence based care using cost-effective methods. | Accountable care organizations(ACOs) |
Created by:
Prof Clark