Chapters 11, 12, 13, & 14
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| show | PPG
🗑
|
||||
| show | point of service (POS) plan
🗑
|
||||
| show | Health Maintenance Organization Act of 1973.
🗑
|
||||
| America's oldest privately owned, prepaid medical group is the | show 🗑
|
||||
| show | preferred provider organization (PPO)
🗑
|
||||
| show | salary paid by independent group
🗑
|
||||
| show | fee for service
🗑
|
||||
| show | not employees and are not paid salaries.
🗑
|
||||
| show | it limits the patients choice of personal physicians
🗑
|
||||
| Practitioners in an HMO program may come under peer review by a professional group called a | show 🗑
|
||||
| A primary care physician who controls patient access to specialists is called a(n) | show 🗑
|
||||
| show | 2014
🗑
|
||||
| Benefits under the HMO Act fall under two categories: __________ health services and supplemental health services. | show 🗑
|
||||
| The abbreviation MCO stands for __________. | show 🗑
|
||||
| The law states that an employer employing __________ or more persons may offer the services of an HMO clinic as an alternative health treatment plan for employees. | show 🗑
|
||||
| A copayment in a managed care plan is usually a fixed dollar amount (predetermined fee). | show 🗑
|
||||
| show | False
🗑
|
||||
| show | True
🗑
|
||||
| In a point-of-service (POS) program, members may choose to use a nonprogram provider at any time. | show 🗑
|
||||
| In a staff model HMO, physicians are hired directly by the health plan that pays their salary. | show 🗑
|
||||
| show | True
🗑
|
||||
| In times past, physicians in private practice billed indemnity insurance plans, and professional services were reimbursed on a fee-for-service basis. | show 🗑
|
||||
| Managed care plans allow laboratory tests to be performed at any facility the patient chooses. | show 🗑
|
||||
| show | False
🗑
|
||||
| Medicare-eligible patients are not involved with HMOs or prepaid health plans. | show 🗑
|
||||
| A claims assistance professional (CAP) | show 🗑
|
||||
| show | identifies claims to review for medical necessity & monitors the number of times given procedures can be billed during a specific time frame.
🗑
|
||||
| show | Medicare-approved charge
🗑
|
||||
| A program that contracts with CMS to review medical necessity and appropriateness of inpatient medical care is known as a(n) | show 🗑
|
||||
| An explanation of benefits document for a patient under the Medicare program is referred to as the | show 🗑
|
||||
| Currently the Part B Medicare annual deductible is | show 🗑
|
||||
| show | deposit the check and then write to Medicare to notify them of the overpayment
🗑
|
||||
| In the Medicare program, there is mandatory assignment for | show 🗑
|
||||
| show | Federal
🗑
|
||||
| Medicare Part A is run by | show 🗑
|
||||
| A Medicare nonparticipating physician may bill no more than the Medicare __________. | show 🗑
|
||||
| A specialized insurance policy that is predefined by the federal government for the Medicare beneficiary to cover the deductible and copayment amounts is referred to as __________. | show 🗑
|
||||
| show | National Provider Identifier
🗑
|
||||
| Medicare outpatient coverage is referred to as Part | show 🗑
|
||||
| show | 65
🗑
|
||||
| A Medicare patient with an HMO does not need a supplemental insurance policy. | show 🗑
|
||||
| show | False
🗑
|
||||
| show | False
🗑
|
||||
| Because Medicare is a federal program providing uniform benefits, payment of each medical service rendered to Medicare patients is consistent across the United States. | show 🗑
|
||||
| show | False
🗑
|
||||
| Each Medicare hospital benefit period consists of 60 consecutive days in a hospital or nursing facility. | show 🗑
|
||||
| Employee and employer contributions help pay for Medicare Part A health services. | show 🗑
|
||||
| Funds for Medicare Part B come equally from those who sign up for it and the federal government. | show 🗑
|
||||
| In the Medicare program, a physical examination is a covered benefit when performed within 12 months of enrollment. | show 🗑
|
||||
| It is possible for an alien to be eligible for Medicare Part A and Part B. | show 🗑
|
||||
| show | handicap needs who require orthopedic treatment or plastic surgery
🗑
|
||||
| DEFRA and CHAP were responsible for | show 🗑
|
||||
| If a physician accepts Medicaid patients, the physician must accept | show 🗑
|
||||
| show | welfare agency directly to the physician
🗑
|
||||
| show | Both month of service and type of service
🗑
|
||||
| show | state government with partial federal funding
🗑
|
||||
| Medicaid is available to needy and low-income people such as the | show 🗑
|
||||
| show | managed care organization and not the Medicaid fiscal agent
🗑
|
||||
| State Children's Health Insurance Programs (SCHIPs) | show 🗑
|
||||
| The federal aspects of Medicaid are the responsibility of the | show 🗑
|
||||
| Medicaid identification cards are usually issued every __________. | show 🗑
|
||||
| show | XIX
🗑
|
||||
| Most states have __________ for Medicaid payments if a patient requires medical care while out of state. | show 🗑
|
||||
| Some Medicaid recipients in the medically needy category must pay a coinsurance payment and/or deductible, also known as a(n) __________ within the eligibility month before state benefits may be received. | show 🗑
|
||||
| show | DEFRA
🗑
|
||||
| show | False
🗑
|
||||
| show | False
🗑
|
||||
| All states processing medical claims must bill using the CMS-1500 claim form. | show 🗑
|
||||
| show | True
🗑
|
||||
| Family planning is a Medicaid basic benefit. | show 🗑
|
||||
| Home health care is never covered under Medicaid. | show 🗑
|
||||
| If a service is totally disallowed by Medicaid, a physician is within legal rights to bill the patient. | show 🗑
|
||||
| In some cases the welfare office may grant retroactive eligibility to a patient. | show 🗑
|
||||
| show | False
🗑
|
||||
| show | False
🗑
|
||||
| A physician who chooses not to participate in TRICARE bills __________ charge. | show 🗑
|
||||
| A health care professional, usually a registered nurse, who helps the patient work with his or her primary care manager to locate a specialist or obtain a preauthorization for care is referred to as a(n) | show 🗑
|
||||
| show | certification from a military hospital stating that it cannot provide the necessary care.
🗑
|
||||
| Enrollment in TRICARE Prime is for | show 🗑
|
||||
| show | doctors of medicine, osteopathy and psychologists
🗑
|
||||
| If a TRICARE Extra claim is submitted with several items and several dates of service, the time limit that would apply to the claim for filing would be | show 🗑
|
||||
| show | cooperative
🗑
|
||||
| People NOT entitled to benefits under TRICARE are | show 🗑
|
||||
| The health maintenance organization provided for dependents of active duty military personnel is called | show 🗑
|
||||
| show | defined by ZIP codes and based on an area of about 40 miles in radius surrounding each USMTF
🗑
|
||||
| show | NAS
🗑
|
||||
| A person who has served in the Armed Forces of the United States, especially in time of war, who is no longer in the service and has received an honorable discharge is called a(n) | show 🗑
|
||||
| show | 10
🗑
|
||||
| An organization under contract to the government that handles insurance claims for care received under the TRICARE program is known as a(n) | show 🗑
|
||||
| show | Veterans Health Administration (formerly CHAMPVA)
🗑
|
||||
| A certified nurse midwife is an authorized provider of health care for TRICARE beneficiaries. | show 🗑
|
||||
| A partnership program permits TRICARE-eligible people to receive inpatient treatment from civilian providers of care in a military hospital. | show 🗑
|
||||
| A person retired from a career in the Armed Forces is eligible for TRICARE until 65 years of age. | show 🗑
|
||||
| show | False
🗑
|
||||
| show | True
🗑
|
||||
| All Privacy Act requests from patients must be made in writing. | show 🗑
|
||||
| show | True
🗑
|
||||
| show | False
🗑
|
||||
| Individuals who qualify for TRICARE are known as subscribers. | show 🗑
|
||||
| show | True
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
csalamon722
Popular Insurance sets