1. An independent, not-for-prfit organization that setsstandards for healthcare in the United States
    The Joint Commission
  2. Managed care is a healthcare system where insurance companies attemt to control _____,____and_____ healthcare.
    cost of, quality of and acess to
  3. What type of managed care organization in which services may be furnished at discounted rates if the members recieve their healthcare from member providers but pay a higher cost when going outside the organization?
    PPO - Prefered Provider Organization
  4. Which of the following is not one of the five categories of problem debtors?

    A. Pay-it-later debtors
  5. A private organization that contracts with Medicare to pay Part A and some of Part B bills is referd to as______.
    fiscal intermediary
  6. Individuals pay for Medicare Part B coverage through ____ ___.
    monthly premiums
  7. Medicare's fee schedule is based on a system whereby each payment value is found within a reange of payments known as _______.
    RBRVS - Resourse-Based relative value scale
  8. When a medicare claim is filed, the beneficiary recieves a document explaning the claim adjudication called a/an ___.
    MSN - Medicre Summary Notice
  9. Studies preformed to improve the process and outcomes of patient care are called ____.
    quality rveiw studies.
  10. Unless an individual has health coverage through his or her employer, when he or she becomes eligible for Medicare, late enrollment can result in ____________________.
    up to two penalties.
  11. Providers that bill FIs can alsosubnit claims electronically using ____ _____ ____.
    direct data entry
  12. The TRICARE program is managed by ____ under the authority of the Office of the Assistant Secretary of Defence for Health Affairs (OSD/HA)
    TRICARE Management Activity - TMA
  13. Military personnel ad their TRICARE-eligible dependants recieve free healthcare at what places?
    Nonprofit facility, federally funded hospital and a military treatment facility (MTF).
  14. When Prime enrollees choose the POS option, all requirements applicable to Standard apply except ______.
    the requirement for an NAS (nonavaliability statement)
  15. The correct form to complete for the nonavailability statement is ______.
    DD Form 1251
  16. Non-Pars may charge up to ___ percent above the TRICARE allowable charge for their services.
  17. Before the health insurance professional can completeand submit a health insurance claim, a ________ is typically necessary.
    Signed and dated release of information.
  18. To compete the entire claims process, a paper claim typically takes ____to_____ weeks
  19. MEdicare's inpatient hospital classification system used to pay a hospital or other provider for services, categorizing illness/conditions by diagnosis and treatment, is called _____.
    DRG - Diagnosis-Relaited Group
  20. A computer softwere program that identifies a pationt's DRG category by interpereting certan coded information is called a ______.
    DRG grouper
  21. The federal entity that sets guidelines and rules that affect the entire healthcare industry and which everyone in this industrymust folow is the ______.
    Centers for Medicare and Medicaid Services - CMS
  22. Electronic transmissions were first used during what decade?
  23. To help improve the healthcare administrative process and, at the same time, simplify it, ______was created
    HIPAA - Health Insurance Portability and Accountability Act
  24. Hospitals that recieve additional payments to ensure that communities have access to certain high-cost services are called ______.
    disproportionate share hospitals
  25. Insurance companies are referred to as ___ payers.
  26. Many FFS policies set a limit for what they will reimburse thier members for any charges incurred, which is referred to as a/an ______.
    lifetime maximum insurance cap
  27. The kindof thealth insurancd paid for by a business entity other than the government is  called ______.
    Commercial health insurance
  28. Many self-insured groups hire a specific type of organization to manage and pay claims called ______.
    administrative service organizations. (ASOs)
  29. If a claim is denied as "untimely"
    and appeal can be submitted in certain cases
  30. On the CMS - 1500 form, patient information is entered into ___________________.
    The top of the form.
  31. The most common format used for computer text files and on the enternet is
    ASC II
  32. Documente needed to complete a paper CMS-1500 include all fo the following EXCEPT

    a. patient information form
    b. patient insurance ID card
    c. Patients driver's license
    d. patient's health record
    The answer is C. Patients drivers license
  33. When the health insurance professional extracts certain informaion from a patient's health record tocomplete the CMS-1500 it's called___________.
  34. One of the recent technological advances that makes verification of patient insurance eligibility easier and faster is the __________________________________.
    Interactive voice responce. (IVR)
  35. The primary objective of a health insurance professional is to________________________.
    submit clean claims.
  36. Congress palssed the Health Maintenance Organization Act in ________
  37. Factors listed in  the text that drive healthcare issues include all the following EXCEPT:

    a. regulating managed care plans
    b. expanding access for uninsured Americans
    c. increasing healthcare costs
    d. stabilizing emergency services
    C. increasing healthcare costs
  38. The acronym for the Congressional act that circumvents problems such as preexisting conditions and other healthcare-related issues is ____________.
  39. Fee-for-Service healthcare plans are also referred to as, _____________.
    Indemnity insurance
  40. The state that has recently implemented a new law to cover its uninsured population is, __________.
  41. College entry-level skills necessary for success as a health insurance professional include all of the following except:

    D. Coding
  42. In order to develop effective study skills, it is suggested that students generate a ________ schedule.
    time management
  43. those who work in healthcare say themost important reward is, _____________.
    helping people
  44. One method of enhancing one's career as a health insurance professional is to aquire, _________.
  45. When a society tends to be hasty in bringing lawsuits, it is said to be, ____________.
  46. Members of a medical team who are not physicians are called ________ members.
  47. The type of contract that exists between a healthcare provider and a patient is a/an ________contract
  48. That act tha tmade Medicare benefits secondary to employer group health plans for employees (or spouses) older than 65 is the, _________________________.
    Tax equity and Fiscal Responsibility Act of 1982
  49. The Office of Inspector General recommends to have a ________________.
    HIPAA compliance plan.
  50. A proposition to create a contract is the ________.
  51. The primary objectives of HIPAA include all of the following EXCEPT to

    B. Lower healthcare costs
  52. The dollar amount that a patient must pay each year before his or her insurance bennefits begin is  called an/a ____________. 
  53. Insurance companies often cap what a patient must pay, which is referred to as the ____________________.
    out-of-pocket maximum
  54. When both basic and major medical coverage is combined into one insurance plan, it is called
    a comprehensive plan
Card Set
Weeks 1-10