Added Insurance Test.txt

  1. Champus is now
  2. Episode of Care
    When all services are paid as lump sum
  3. NCQA (National Committee for Quality Assurance) enforces
    quality assurance
  4. HCFA (Health Care Financing Administration) is now
  5. The office of the Inspector General handles
    health insurance fraud
  6. Agency established to administer Medicare and Medicaid was
    • Health Care Financing Administration
    • HCFA
  7. Reimbursement method for inpatient billing is
    • DRG’s
    • Diagnostic related groups
  8. Medicare reimbursement is calculated based on
    • Resource Based Related value Scale
    • RBRVS
  9. Fraud
    is intentional deception that results to unauthorized payment
  10. Organization that contracts CMS to process Medicare claims is the
    Fiscal Intermediary
  11. Common Law
    is based on court decision that established a precedent
  12. Capitation
    is a pre-established payment of the carrier to the provider for care of enrollees each month
  13. Subpoena Duces Tecum
    requires original document to be presented in court.
  14. Qui Tam
    allows even a private citizen to sue in court any government contractor that did fraud
  15. Patients with AIDS need to sign an
    additional release of information authorization
  16. Confidentiality
    restricts patient information access
  17. HIPAA
    a legislation passed in 1996 about health insurance reform
  18. Statutes
    are laws passed by legislative bodies
  19. Deposition…
    Testimony under oath outside the court
  20. Subpoena…
    order for witness to appear in court
  21. COBRA…
    allows terminated employee to continue his employer-sponsored health insurance coverage
  22. Federal Register is a
    legal newspaper published on daily basis that has codes of federal regulations and newly passed legislation and regulation.
  23. Contract
    An agreement between two or more parties to perform specific services
  24. Forerunners of the present HMO’S were the __________ health plans
  25. Hold Harmless Clause
    Patient is not responsible for what the carrier didn'’t cover
  26. What year was HIPAA put into legislation?
Card Set
Added Insurance Test.txt
Some terms regarding health insurance