Chapter 2 Exam

Front 1

Medicare

Back 1

also know as Title XVll of the Social Security Act (SSA) of 1965, provides healthcare to Americans 65 and older.

Front 2

HIPPA

HIPPA - mandates regulations that govern:

Back 2

Health Insurance Portability and Accountability Act... created to:

-give patients better access to insurance

-limit fraud and abuse

-reduce administrative costs

-Security

-Privacy

-Electronic transaction standards for health information

Front 3

Medical Care

Back 3

The diagnosis and treatment of those who are sick, injured or concerned about their health by members of a healthcare team

Identify (diagnose) the illness and provide care (treat)

Front 4

Copayment

Back 4

Provision in insurance policy that policyholder or patient pays a specific dollar amount to the provider for each visit or medical service rendered

Specific amount patient pays for each doctor visit (set by the insurance company

Front 5

Group Health Insurance Coverage

Back 5

Healthcare coverage available through employer/organization and the employer/organization pays part of all of the premium costs

Front 6

Preventative Services

Back 6

Provide early detection of health problems and allows treatment options that are less expensive and dramatic

Front 7

Disability Insurance

Back 7

Is just one of many different types of insurance coverage.

Front 8

Hospitalist and Residents

Back 8

Practice medicine only in a hospital setting.

Front 9

2007 Census data estimates

Back 9

Approximately 85% of people in the U.S. were covered by health insurance

Front 10

Health insurance is available to individuals who

Back 10

-Participate in individual health plans

-Participate in prepaid health plans

-Participate in group health plans

Front 11

What introduced the first insurance policy?

Back 11

Franklin Health Assurance Company of Massachusetts

Front 12

MCR

Back 12

Medicare Contracting Reform initiative was established to integrate the administration of Medical parts A & B

Front 13

Who provided Worker's Compensation for federal employees of the federal employees in unusually hazardous jobs?

Back 13

President Theodore Roosevelt signed legislation in 1908

Front 14

Federal Employees' Compensation Act replaced the 1908 worker's compensation legislation and civilian employees of the federal government with

Back 14

-Medical Care

-Survivor Benefits

-Compensation for lost wages

Front 15

TPAs

Back 15

Third Party Administrators administer healthcare plans process claims they serve as a system of checks and balances for labor and management.

Front 16

2007 census data showed 28% of people in the U.S.

Back 16

Are covered by government plans (Medicare, Medicaid and Tricare).

Front 17

Insurance companies guarantee payment

Back 17

To the insured in the event of an unforeseen event in exchange for a monthly premium.

Front 18

POR

Back 18

Problem-Oriented Record is a systematic method of documentation that consists of

-Initial plan

-Progress Notes

-Data base

Database collects several pieces of information, including :

-Chief complaint

-Review of systems (ROS)

-Present condition and diagnosis

-Physical exam

Front 19

IPF PPS=

Back 19

Inpatient Psychiatric Facility Prospective Payment System was begun January 1, 2005.

Front 20

Worker's Compensation

Back 20

is mandated by federal and state government and requires employers to cover medical expenses and lost wages for employees injured on the job.

Front 21

OSHA

Back 21

Occupational Safety and Health Administrative Act of 1970 was designed to protect employees against injuries due to occupational hazards in the workplace.

Front 22

Tricare has three plans options:

Back 22

-Tricare Standard

-Tricare Prime

-Tricare Extra

Front 23

OPPS

Back 23

Outpatient Prospective Payment Systems uses the Ambulatory Payment Classification (APCs) to calculate reimbursement for billing of hospital-based Medicare outpatient claims.

Front 24

Who had the first Blue Shield plan?

Back 24

California

Front 25

CLIA

Back 25

Clinical Laboratory Improvement Act established quality standards for all laboratory testing in a variety of settings.

Deals with standards for laboratory testing

Front 26

Major Medical Insurance

Back 26

Provides coverage for catastrophic or prolonged illness and injuries

Front 27

Deductible

Back 27

The amount the patient is financially responsible for before insurance pays

Front 28

HMO

Back 28

Provide healthcare services to subscribers in a given geographical area for a fixed fee

Front 29

NCCI

Back 29

National Correct Coding Initiative... promotes correct coding methodologies

Front 30

What is Insurance?

Back 30

is essentially a contract that protects from loss

Front 31

Total Practice Management software automates the following medical practice functions:

Back 31

-Registering patients

-Scheduling patients

-Generate claims and patient statements

-Process payments form patient and third party payer

-Produce administrative and clinical reports

Front 32

Coinsurance

Back 32

The percentage of cost the patient shares with the health plan

Front 33

Based Period

Back 33

Weekly benefit amount divided into quarters

Front 34

Title XIX of the SSA of 1965 deals with Patient record

Back 34

Patient visit documentation

Front 35

Prepaid health plans

Back 35

Were the forerunners of today's managed care plans.