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MED 211
FINAL EXAM STUDY GUIDE
50
Insurance
Undergraduate 2
11/13/2012

Additional Insurance Flashcards

 


 

Cards

Term
originally covered for hospital services
Definition
Blue Cross plans
Term
for physician services
Definition
Blue Shield
Term
The abbreviation UCR stands for
Definition
usual, customary, and reasonable
Term
a form of prospective authorization
Definition
Precertification
Term
varies according to the plan in which the patient is enrolled
Definition
Annual deductibles
Term
The health insurance specialist should re-bill any BCBS claims not paid within
Definition
30days
Term
covers a specific portion of patients' bills relating to institutional providers for inpatients, hospice, and home health
Definition
Medicare Part A
Term
Medicare Part A is available at no cost to individuals
Definition
age 65 or older and who currently receive retirement benefits from Social Security, qualify to receive retirement benefits from Social Security but have ot yet applied for benefits and had Medicare-covered government employment
Term
Medicare nonPAR physicians may elect to accept assignment on
Definition
a case-by-case basis
Term
The Medicare Summary Notice is
Definition
an easy-to-read monthly statement that clearly lists health insurance claims information for beneficiaries
Term
Medicare part D plan was created in part to
Definition
assist beneficiaries with outpatient prescription drug costs
Term
Medicare non-participating providers (nonPARs) are allowed to charge
Definition
15% more than a PAR provider for covered services
Term
NonPAR physicians and surgeons must notify beneficiaries in writing of
Definition
projected out-of-pocket costs for elective surgery and noncovered procedures when the charge is $500 or more
Term
Balance billing of Medicare patients is
Definition
prohibited
Term
Patients facing an emergency or urgent health situation connot be asked by a provider to sign a
Definition
private contract
Term
Medicaid is
Definition
state administered and federally mandated
Term
State Medicaid programs vary from
Definition
state to state
Term
Medicaid is a government assistance program designed to help
Definition
individuals with medical expenses
Term
Medicaid eligibility has to be verified at each
Definition
encounter
Term
Not all Medicaid recipients must pay a
Definition
monthly premium
Term
Copayments are required for some categories of
Definition
Medicaid recipients
Term
Individuals classified as medically needy have
Definition
out-of-pocket expenses
Term
Temporary Assistance for Needy Families (TANF) provides time-limited cash assistance for
Definition
children deprived of support because of a parent's death, incapacity, absence, or unemployment
Term
State Medicaid programs will pay the Medicare premium, deductible, and coinsurance for qualified Medicare beneficiaries (QMB) with
Definition
low monthly income and limited resources
Term
Medicaid reimburesement information sent to the provider is called the
Definition
remittance advice
Term
Additional health and liability programs are always considered primary to
Definition
Medicaid
Term
When filing a Medicaid secondary claim, the remittance advice fromt he primary payer must be
Definition
attached
Term
There are 3 TRICARE regions located in
Definition
the United States
Term
The catastrophic cap benefit was put into effect to protect beneficiaries from
Definition
devastating finacial loss due to serious illness or long-term treatment
Term
TRICARE Prime is similar in design to
Definition
a civilian HMO
Term
TRICARE Extra is a
Definition
PPO option
Term
Annual enrollment is not necessary for
Definition
TRICARE Extra
Term
TRICARE Standard is a
Definition
fee-for-service option
Term
TRICARE Standard allows the greatest freedom in selecting
Definition
civilian providers
Term
Providers may enroll in TRICARE Standard on a
Definition
case-biy-case basis
Term

The nonavailability statement (NAS) is a certificate issued at a treatment facility when a

Definition

·        particular service cannot be performed at a military treatment center.

Term

TRICARE is secondary to

Definition

·        commercial medical insurance policies.

Term

Survivors of veterans who died in the line of duty (without misconduct) would be eligible for

Definition

CHAMPVA

Term

The program designed to provide medical treatment and other benefits for respiratory conditions related to former employment in a coal mine is the

Definition

Federal Black Lung Program

Term

Working while impaired by an illicit drug would preclude an employee from receiving workers’ compensation benefits with an

Definition

on-the-job injury

Term

The OSHA Act of 1970 was enacted by Congress to protect employees against injuries from

Definition

occupational hazards in the workplace

Term

Obtaining and retaining MSDS (Material Safety Data Sheets) is an

Definition

OSHA requirement

Term

Employees who, during the normal course of their job, may come into contact with human blood and other potentially infectious materials must be offered

Definition

the hepatitis B vaccine

Term

The employer carries the burden of the cost and  is responsible for paying

Definition

·        workers’ compensation premiums

Term

The employer must be contacted immediately by the treating provider to ensure

Definition

proper handling of all job-related injuries or conditions.

Term

The provider  is responsible for completing the

Definition

First Report of Injury form

Term

The filing deadline for the First Report of Injury form

Definition

varies from state to state

Term

The patient’s signature is not required on

Definition

the workers’ compensation claim

Term

If the workers’ compensation carrier requests further medical information about the claim, it is the provider’s responsibility to

Definition

provide the information

Term

If a patient’s workers’ compensation claim is denied, the patient is allowed to file an

Definition

·        appeal regarding the denial.

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