chp 11-18
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| show | ross-loss medical group
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| kaiser permanente's medical plan is a closed panel program, which means | show 🗑
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| how are physicians who work for a prepaid group practice model paid? | show 🗑
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| show | foundation for medical care
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| in an independent practice association (IPA), physicians are | show 🗑
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| an organization that gives members freedom of choice among physicians and hospitals and provides a higher level of benefits if the providers listed on the plan are used is called a(n) | show 🗑
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| a physician owned business that has the flexibility to deal with all forms of contract medicine and also offers its own plans is a(n) | show 🗑
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| show | point-of-service (POS) plan
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| practitioners in an HMO program may come under peer review by a professional group called a | show 🗑
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| when a physician sees a patient more than is medically necessary, it is called | show 🗑
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| show | teritiary
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| show | collect the copayment when the patient arrives for the office visit
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| show | the centers for medicare and medicaid services
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| medicare is a _____ health insurance program | show 🗑
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| the letter "d" following the identification number on the patient's medicare card indicates a | show 🗑
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| show | railroad retiree
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| show | once every 24 months
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| when a medicare beneficiary has employer supplemental coverage, medicare refers to these plans as | show 🗑
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| some senior HMOs may provide services not covered by medicare, such as | show 🗑
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| a participating physician with the medicare plan agrees to accept 80% of the | show 🗑
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| a medicare prepayment screen | show 🗑
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| under the prospective payment system (PPS), hospitals treating medicare patients are reimbursed according to | show 🗑
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| payments to hospitals for medicare services are classified according to | show 🗑
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| show | MAAC
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| the HCPCS national alphanumeric codes are referred to as level ____ codes | show 🗑
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| show | fiscal intermediaries
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| the federal emergency relief administration made funds available to pay for | show 🗑
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| in the medicaid program, congress authorized vendor payments for medical care, which are payments from the | show 🗑
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| DEFRA and CHAP were responsible for | show 🗑
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| show | CMS
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| state childrens health insurance program (SCHIPs) | show 🗑
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| show | provided assistance for the aged and disabled who are receiving medicare and whose incomes are below the poverty level
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| show | blind, disabled, aged (65 years or older)
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| basic maternal and child health program (MCHP) provisions offered in all states include children with | show 🗑
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| show | the medicaid-allowed amount
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| show | month, type
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| show | EPSDT
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| the three choices of health care coverage for families of active duty military personnel, military retirees, and their dependents are | show 🗑
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| people not entitled to benefits under tricare are | show 🗑
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| show | DEERS
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| an NAS is a certification | show 🗑
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| medical care that is cost-shared by both tricare standard and a civilian source is known as ____ care | show 🗑
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| show | october 1 to september 30
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| health care professionals who may treat a tricare patient are | show 🗑
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| show | HCF
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| a physician who chooses not to participate in tricare bills ____ charge | show 🗑
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| the time limit within which a tricare outpatient claim must be filed is ______ a service is provided | show 🗑
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| the time limit within which a tricare inpatient claim must be filed is within | show 🗑
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| tricare prime and tricare extra claims are | show 🗑
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| if a tricare extra claim is submitted with ever several items and several dates of service, the time limit that would apply to the claim for filing would be | show 🗑
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| name two kind of statutes under workers compensation | show 🗑
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| an unexpected, unintended event that occurs at a particular time and place, causing injury to an individual not of his or her own making, is called a/an | show 🗑
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| show | occupational illness or disease
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| name the federal workers compensation acts that cover workers | show 🗑
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| show | compulsory law
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| show | elective law
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| show | 1)monopolistic state or provincial fund 2)territorial fund 3)self insurers 4) competitive state fund 5)private insurance company
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| who pays the workers compensation insurance premiums? | show 🗑
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| five types of workers compensation benefits | show 🗑
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| two types of workers compensation claims and the differences among them | show 🗑
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| show | permanent disability claim- patient is usually on TD benefits for a period of time and then goes on permanent disability
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| show | percentage of employees earning at the time of the the injury
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| show | work hardening
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| when an industrial case reaches the time for rating the disability, this is accomplished by what state agency? | show 🗑
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| show | Yes. The workers compensation board or the industrial accident commission
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| when fraud and abuse is suspected in a workers compensation case, the physician should report the situation to | show 🗑
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| third party subrogation | show 🗑
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| when an individual suffers a work related injury or illness, the employer must complete and send a form called a/an______ to the insurance company and workers compensation state offices. | show 🗑
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| if the employee is sent to a physicians office for medical care, the employer must complete a form called a/an ______, which authorizes the physician to treat the employee | show 🗑
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| employers are required to meet health and safety standards for their employees under federal and states statutes known as the | show 🗑
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| the process of carrying on a lawsuit is called | show 🗑
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| a proceeding during which an attorney questions a witness who answers under oath but no in open court is called a/an | show 🗑
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| the legal promise of a patient to satisfy a debt to the physician from proceeds received from a litigated case is termed a/an | show 🗑
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| show | insurance carrier, employer, state workers compensation office
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| show | true
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| a stamped physicians signature is acceptable on the doctors first report of occupational injury or illness form | show 🗑
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| in a workers compensation case, bills should be submitted monthly or at the time of termination of treatment, and a claim becomes delinquent after a time frame of 45 days | show 🗑
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| name the states that have nonindustrial state disability programs | show 🗑
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| show | california, hawaii, new jersey, rhode island
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| two federal programs for individuals younger than 65 years of age who have a severe disability are | show 🗑
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| show | exclusions
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| when an individual who is insured under a disability income insurance policy cannot perform one or more of his/her regular job duties, this is known as | show 🗑
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| health insurance that provides monthly or weekly income when an individual is unable to work because of nonindustrial illness or injury is called | show 🗑
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| another disability income insurance term for benefits is | show 🗑
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| show | noncancelable clause
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| provisions that limit the scope of insurance coverage are known as | show 🗑
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| show | disability determination services
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| show | waiting period
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| when a person insured under a disability income insurance policy cannot, for a limited period of time, perform all functions of his or her regular job duties, this is known as permanent disability | show 🗑
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| to be eligible to apply for disability benefits under social security, an individual must be unable to perform any type of work for a period of not less than 12 months | show 🗑
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| when a claim form is submitted for a patient applying for state disability benefits, the most important item required on the form is the claimant's social security number | show 🗑
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| show | interim per diem paid for reach day in the hospital
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| discounts in the form of sliding scale | show 🗑
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| show | hospital buys insurance to protect against lost revenue and receives less of a capitation fee
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| show | method in which part of plan's payment to the hospital may be withheld and paid at the end of the year
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| charges | show 🗑
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| ambulatory payment classifications | show 🗑
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| case rate | show 🗑
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| diagnosis-related groups | show 🗑
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| show | hospital receives a flat per admission payment for the particular service to which the patient is admitted
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| show | plan advances cash to cover expected claims to the hospital
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| show | when a managed care plan leases beds from a hospital and pays per bed whether used or not
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| differential by day in hospital | show 🗑
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| show | reimbursement to the hospital on a per member per month basis
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| per diem | show 🗑
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| percentage of revenue | show 🗑
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| show | cost outliers
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| an individual who receives medical service in a section or department of the hospital and goes home the same day is called a/an | show 🗑
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| a surgical procedure that may be scheduled in advance, is not an emergency, and is discretionary on the part of the physician and patient is called | show 🗑
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| show | comorbid condition
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| show | true
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| show | chronological
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| when an individual plans to start an insurance billing company, he/she should have enough funds to operate he business for a period of | show 🗑
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| under HIPPA regulations, if a physician's insurance billing is outsourced to a person, this individual is known as/an ____ because he/she uses and discloses individuals identifiable health information | show 🗑
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| when insurance billing is outsourced to a company, a document should be created, signed, and notarized by both parties known s a | show 🗑
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| show | mentor
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Created by:
PNSlagill