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HIT 130 Quiz4 Review
HIT 130 Quiz 4 Review
| Question | Answer |
|---|---|
| A program that provides health insurance to all uninsured children and teens who are not eligible for or enrolled in Medical Assistance. | CHIP |
| A jointly financed program by the state and federal government to provide health insurance for children through the Medicaid program. | SCHIP |
| A time-limited (5 years) cash assistance benefit for families that qualify based on the state income or poverty level. | TANF |
| A government program funded by general taxes that helps pay living expenses for low-income older people and those who are blind or have disabilities. | SSI |
| A government program that provides an alternative to institutional care for persons age 55 or older who require nursing-facility level of care. | PACE |
| What is the term used under Medicaid when other insurance carriers will be approached first for payment? | Payer of last resort |
| What program requires an individual to spend a portion of her income or resources until she is at or below the state's income level? | Spend-down program |
| People who are termed medically needy have too much money to be categorized as _______ needy. | categorically |
| Medicaid is paid by: | the federal and state government |
| What term identifies when a patient has Medicare beneficiary also receives help from the Medicaid program? | Medi-Medi |
| Which organization is responsible for determining the type, amount, and scope of services covered by Medicaid? | Each state government |
| When a TRICARE beneficiary needs treatment that is NOT available from a military treatment facility (MTF), the: | beneficiary must obtain a nonavailability statement (NAS) to receive services from a civilian provider. |
| What is the meaning of the acronym NAS? (Under TRICARE) | Nonavailability statement |
| Which TRICARE plan has with the lowest out-of-pocket costs? | TRICARE Prime |
| What is the meaning of the acronym PCM under TRICARE? | Primary Care Manager |
| The Department of Defense (DoD) medical entitlement program for uniformed services beneficiaries is____________________. | TRICARE |
| Which entity administers the CHAMPVA ? | Veteran's Administration (VA) Health Administration Center |
| When the covered beneficiary is responsible for a portion of the total healthcare costs, this is known as ____________________. | cost-sharing |
| What is the name of the steps that result in an insurance carrier's decision to either pay or deny a claim? | Adjudication |
| Maximum amount an insurance payer considers reasonable for a medical service. | Allowed charges |
| Amount of healthcare expenses for which a policyholder or patient is responsible. | Out-of-pocket |
| A fee determined by third-party payers to reimburse providers based on the provider's normal fee, the range of fees charged by providers of the same specialty in the same geographic area. | UCR |
| The term to identify the difference between the billed amount and the allowed amount. | Write-offs |
| Patient Responsibility | Allowed Amount x Coinsurance Rate= |
| Write-off | Billed Charge -Allowed Amount= |
Created by:
Prof Clark