Shared Flashcard Set

Details

Med 211 Final
Insurance
50
Insurance
Undergraduate 1
09/01/2011

Additional Insurance Flashcards

 


 

Cards

Term
Blue Cross
Definition
originally covered for hospital service
Term
Blue Sheild
Definition
plans for physician services
Term
URA stands for
Definition
usual, customary, and reasonable
Term
Precertification
Definition
form of prospective authorization
Term
30 days
Definition
Health insurance specialist should re-bill any BCBS claims not paid within
Term
Medicare Part A
Definition
covers bills relating to institutional providers for inpatients, hospice and home health
Term
Medicare part A
Definition
no cost to individuals 65 or older,and who currently receive retirement benefits from Social Security,but have not applied for benefits and had Medicare-covered government employment
Term
case-by-case
Definition
Non participating physicians may elect to accept assignments on a
Term
Medicare Summary Notice
Definition
an easy to read monthly statement that clearly lists health insurance claims information for beneficiaries
Term
Medicare part D
Definition
created to assist beneficiaries with outpatient prescription drug cost
Term
Medicare nonPARS
Definition
allowed to charge 15% more than a PAR provider for covered services
Term
Non PARS and surgeons
Definition
must notify beneficiaries in writing of projected out-of-pocket costs for elective surgery and noncovered procedures when the charge is $500 or more
Term
prohibited
Definition
balance billing of Medicare patients is
Term
private contract
Definition
Patients facing an emergency or urgent health situation cannot be asked by a provider to sign a
Term
Medicaid
Definition
state administered and federally mandated
Term
state to state
Definition
Medicaid programs very from
Term
Government assistance program
Definition
Medicaid is a program designed to help individuals with medical expenses
Term
encounter
Definition
Medicaid eligibility has to be verified at each
Term
False
Definition
All Medicaid recipients must pay a monthly premium
Term
Pay a copayment
Definition
What are Medicaid recipients required for some categories to do?
Term
True
Definition
Individuals classified as medically needy have out-of-pocket expenses
Term
Temporary Assistance for Needy Families (TANF)
Definition
provides time-limited cash assistance for children deprived of support because of a parent's death, incapacity, absence, or unemployment
Term
State Medicare
Definition
will pay the Medicare premium, deductible, and coinsurance for qualified Medicare beneficiaries (QMB) with low monthly income and limited resources
Term
remittance advice
Definition
Medicaid reimbursement information sent to the provider is called the
Term
False
Definition
Additional health and liability programs are never considered primary to Medicaid
Term
Remittance advice
Definition
What must be attached by the primary payer when filing a Medicaid secondary claim
Term
Three
Definition
How many TRICARE regions are located in the US
Term
TRICARE
Definition
A health care program of active duty members of the military and their qualified family members,CHAMPUS-eligible retirees and their qualified family members, and eligible survivors of members of the uniformed services
Term
The catastrophic cap
Definition
A benefit that was put into effect ot protect beneficiaries from devastation financial loss due to serious illness or long-term treatment
Term
TRICARE Prime
Definition
similar in design to a civilian HMO
Term
TRICARE EXTRA
Definition
is a preferred provider organization (PPO)
Term
TRICARE Standard
Definition
is a fee-for-service option
Term
True
Definition
Annual enrollment is not necessary for TRICARE Extra
Term
TRICARE Standard
Definition
Allows the greatest freedom in selection civilian providers
Term
case-by-case basis
Definition
Providers may enroll in TRICARE Standard on a
Term
NAS nonavailabilty statement
Definition
is a certificate issued at a treatment facility when a particular service cannot be performed at a military treatment center
Term
True
Definition
TRICARE is secondary to commercial medical insurance policies
Term
CHAMPVA
Definition
survivors of veterans who died in the line of duty (without misconduct) would be eligible for
Term
Federal Black Lung Program
Definition
A program designed to provide medical treatment and other benefits for respiratory conditions related to former emplyment in a coal mine is
Term
True
Definition
working while impaired by an illicit drug would preclude an employee from receiving workers' compensation benefits with an on-the-job injury
Term
OSHA
Definition
What was enacted by congress to protect employees against injuries from occupational hazard in the workplace
Term
MSDS (Material Safety Data Sheets)
Definition
obtaining and retaining is a OSHA requirement
Term
hepatitis B vaccine
Definition
Employees who, during the normal course of their job may come into contact with human blood and other potentially infectious materials must be offered the
Term
Employer
Definition
Who carries the burden of the cast and is responsible for paying workers' compensation premiums
Term
True
Definition
the employer must be contacted immediately by the treating provider to ensure proper handling of all job-related injuries or conditions
Term
Provider
Definition
Who is responsible for completing the First Report of Injury form
Term
False
Definition
the filing deadline for completing the First Report of Injury is the same from state to state
Term
True
Definition
The patients signature is not required on the workers' compensation claim
Term
providers responsibility
Definition
If the workers' compensation carrier requests further medical information about the claim who provides that information
Term
True
Definition
If a patient's workers' compenstion claim is denied, the patient is allowed fot file an appeal regarding the denial
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