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Health Insurance

HI chp 2

QuestionAnswer
What is a contract between a policybolder and a third-party payer or government program to reimburse the policyholder for all or a portion of the cost of medically necessary treatment or preventive care provided by healthcare professionals? Health insurance
At Baylor University in Dallas, TX, Justin Ford Kimball introduced a plan to guarantee school teachers 21 days of hospital care for $6 a year. What is this considered? First Blue Cross plan
Who administer healthcare plans and process claims thus serving as a system of checks and balances for labor and management? Third-party administrators (TPAs)
What insurance provides coverage for catastrophic or prolonged illnesses or injuries? Major medical
What is the amount for which the patient is financially responsible before an insurance policy provides payment? Deductible
What provides healthcare services to Americans over the age of 65? Medicare
What is a cost-sharing program between the federal and state governments to provide healthcare services to low-income Americans? Medicaid
What does the acronym OSHA mean? Occupational Safety and Health Administration
What is a provision in an insurance policy that requires the policyholder or patient to pay a specified dollar amount to a healthcare provider for each visit or medical service received? Copayment (copay)
What is the percentage of costs a patient shares with a health plan? Coinsurance
What does the acronym RBRVS mean? Resource-Based Relative Value Scale
On what three components does the RBRVS system reimburse physicians' practice expenses? Physician work, practice expense, and malpractice insurance expense
What is a list of predetermined payments for healthcare services provided to patients? Fee-schedule
What does the acronym NCCI mean? National Correct Coding Initiative
What does the acronym HIPAA mean? Health Insurance Portability and Accountability Act
What was implemented for billing of hospital-based Medicare outpatient claims? Outpatient Prospective Payment System (OPPS)
What does the acronym APC mean? Ambulatory Payment Classifications
What does the acronym EIN mean? Employer Identification Number
What does the acronym NPI mean? National Provider Indentifier
What format does a POR use for documentation? SOAP
What is a global concept that includes the collection of patient information documentation by a number of providers at different facilities regarding one patient? Electronic health record
Who offers healthcare coverage that is called group health insurance? Employers
Created by: YTIMBC
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