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A mass of unnaturally distended veins in the anal canal that lie just inside or outside the rectum is called

Hemorrhoids

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A disorder of carbohydrate metabolism that is characterized by high concentrations of sugar in the blood and results from insufficient production or utilization of insulin is called

Diabetes mellitus

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Gastroscopy is:

Examination of the stomach with an endoscope

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Abnormally low blood sugar is called

Hypoglycemia

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A hiatal hernia is:

A type of gastrocele

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Anorexia means:

Loss of appetite for food

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Excision of the vermiform appendix

appendectomy

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The term renal pertains to

The kidney

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Blood in the urine is called:

Hematuria

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A term that means destructive to kidney tissue is:

Neprhotoxic

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A term for tumor found on mucosal surfaces such as the inner lining of the bladder is:

Polyp

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Urinary incontinence is:

Inability to hold urine in the bladder

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Urinary retention is:

Inability to empty the bladder

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Using ultrasound to study the kidney is called:

Nephrosonography

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Filtering blood to maintain proper balance

Hemodialysis

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Inflammation of the kidney

Nephritis

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Medicare-eligible patients are not involved with HMOs or prepaid health plans

False

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Exclusive provider organizations (EPOs) are regulated by the federal government

False

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In a point of service (POS) program members nay choose to use a nonprogram provider at any time

True

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Managed care plans allow laboratory tests to be performed at any facility the patient chooses

False

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Usually there are no deductibles for managed care plans

True

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A copayment in a managed care plan is usually a fixed dollar amount (predetermined fee)

True

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A significant contribution to HMO development was the

Health maintenance Organization Act of 1973

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When an HMO is paid a fixed amount for each patient served without considering the actual number or nature of services provided to each person this is known as

Capitation

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In an independent practice association (IPA) physicians are

Not employees and are not paid salaries

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An organization that gives members freedom of choice among physicians and hospitals and provided a higher level of benefits if the providers listed on the plan are used is called

Preferred provider organization (PPO)

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A program that offers a combination of HMO-style cost management and PPO-style freedom of choice is

Point of Service (POS)

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The abbreviation MCO stands for

Managed Care Organizations

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An evaluation of the quality and efficiency of services rendered by a practicing physician or physicians within a specialty group

Peer Review

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UR is the abbreviation for

Utilization review

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When a managed care plan requires the primary care physician to seek approval before referring a patient to a specialist it is called obtaining

Prior Approval

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When a capitated patient’s services go over a certain amount and the physician can begin asking the patients to pay (fee for service) this arrangement is provided in a

Stop-loss

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All persons age 65 who meet eligibility requirements for Medicare receive Medicare Part B

False

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Medicare provides insurance for disable workers of any age

True

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Employee and employer contributions help pay for Medicare Part A health services

True

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Medicare Part A is called supplementary medical insurance (SMI)

False

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A Medicare patient with an HMO does not need supplemental insurance policy

True

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When a Medicare recipient chooses a Medicare senior plan he or she forfeits the Medicare card

False

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the assignment on a patient with Medicare-Medicaid must always be accepted or Medicaid will not pick up the residual

True

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Medicare Part A is run by:

The Centers for Medicare and Medicaid Services

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Medicare is a

Federal Health Insurance Program

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The letter preceding the number on the patient’s Medicare identification card indicate

Railroad retiree

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A participating physician with the Medicare plan agrees to accept

80% of the Medicare-approved charges

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The time limit for submitting a Medicare claim is

The end of the calendar year following the fiscal year in which services were performed

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When a Medicare carrier transmits a Medigap claim electronically to the Medigap carrier it is referred to as

Crossover claim

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Medicare outpatient coverage is referred to as part

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The Civil Monetary Penalties Law carries a sanction for penalty of up to

$2,500 for each item

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An NPI number issued to a provider by CMS is the acronym for

National Provider Identifier

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HMO:

Health Maintenance Organization

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POS:

Point of Service

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PPO:

Preferred provider Organization

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Created by: c.vallejo