MBC 103 Final Review

Which is submitted to the payer requesting reimbursement?

The eHealth Exchange is a health information exchange network for...

SNF PPS generates per diem payments. These payments are case-mix adjusted using a resident classification system called?

MACRA makes important changes to how Medicare pays those who provide care to Medicare beneficiaries by...

Which is a private, not-for-profit organization that assesses the quality of managed care plans in the United States?

Which is a centralized health care system adopted by some Western nations and funded by taxes?

When a health insurance plan’s prior approval requirements are not met by providers, what happens?

If the physician profits from the capitation payment model, the physician can do what with that profit?

The Outpatient Prospective Payment System (OPPS), uses ___ to calculate reimbursement.

Which is an insurance agreement that protects business contents against fire, theft, and other risks?

Which provides coverage for catastrophic or prolonged illnesses and injuries?

MCO is responsible for the health of a group of ___ and can be a health plan, hospital, or physician group.

Triple option plans try to prevent covering members who are sicker than the general population, This is ____ Selection.

Which is associated with participating physicians who are members of an independent multi-specialty group practice?

Which documents health care services provided to a patient and includes patient demographic data?

The Centers for Medicare and Medicaid Services (CMS) agency is located in the what?

This patient record is created for a single medical practice

A global concept that includes the collection of patient information by several providers at different facilities.

Accountable care organizations...

Which was created by the MMA to identify and recover improper Medicare payments?

Which classification system was developed by the WHO and used to collect data for statistical purposes?

This program resulted from the BBA and requires quality assurance activities to improve Medicare Part C.

Which act resulted in a prospective payment system (PPS) that issues a predetermined payment for inpatient services?

Which is Latin for “let the master answer?”

Which organization offers the CMRS exam?

The word embezzle means to (what?)

This insurance has a goal to provide every individual with access to health coverage.

Which legislation provides employees of the federal government with medical care, and compensation for lost wages?

Which guarantees repayment for financial losses resulting from an employee’s act or failure to act?

The Electronic Submission of Medical Documentation System (esMD) was implemented to...

This is a method of controlling health care costs & quality of care by reviewing the appropriateness & necessity of care

The HMO Assistance Act defines a federally qualified HMO as being certified to provide healthcare to ___ enrollees

Which is associated with health care that is provided in an HMO-owned center or satellite clinic?

A GPWW establishes a contract that allows physicians to maintain their own offices and share services.

Which type of health insurance coverage is subsidized by employers and other organizations?

A managed care network that contracts with insurance companies to provide healthcare to subscribers for a discounted fee

Many states have enacted legislation requiring a ___ to review health care provided by managed care organizations.

Linking procedure codes reported on a claim to a condition code that justifies the necessity of performing that service.

Managed health care was developed as a way to provide affordable, comprehensive, prepaid health care services to ___?

The primary purpose of the patient record is to provide for ___ of care, which involves documenting patient care.

Which serves as a system of checks and balances for labor and management?

This is contracted healthcare services that are delivered to subscribers by individual physicians in the community.

UROs establish a utilization management program and perform external utilization review services.

With a physician-hospital organization (PHO) The physicians ___ and provide health care services to plan members.

Which defines a profession, delineates qualifications and responsibilities, and clarifies supervision requirements?

The process of reporting ____ as numeric and alphanumeric characters on the insurance claim is called coding.

This is when people are grouped for insurance and the cost of health care coverage is determined by employees’ demos.

Medicare established the QISMC to ensure the accountability of managed care plans in terms of objective, measurable ___

Managed care plans that are “federally qualified” and those that must comply with state quality review mandates, or ___

Which is another name for a health insurance specialist?

This HMO contracts health services delivered to subscribers by physicians who remain in their own office settings.

Which type of health insurance coverage has costs that are typically less per person and provides broader coverage?

The National Committee for Quality Assurance (NCQA) reviews managed care plans and develops report cards to ____.

Which type of health insurance coverage includes federal and state government health programs?

A claims examiner reviews health-related claims to determine whether the charges are reasonable, and also...

The Home Health Prospective Payment System (HH PPS) reimburses home health agencies at a ___ rate.

The Healthcare Common Procedure Coding System (HCPCS) consists of ___ codes.

The principles of right or good conduct and includes rules that govern the conduct of members of a profession.

HMO provides comprehensive health care services to voluntarily enrolled members on a _____ basis.

A management service organization (MSO) provides practice management services to ___

The CPT manual is published by the ____?

Which type of health insurance coverage is purchased by families who do not have access to employer-subsidized coverage?

The organization that hires a ___ is not liable for the acts or omissions of that individual.

Which performs utilization and quality control review of health care furnished to Medicare beneficiaries?

Independent contractors should purchase ___ liability insurance, which protects them from liability due to errors.

The IMPACT Act is what?

After completing an internship, the facility will require students to sign a nondisclosure agreement to protect what?

Providers who participate in an Advanced APM through Medicare Part B...

SCHIP was established to provide health assistance to uninsured, low-income children under what state program?

What is associated with health care that is provided by individuals who are not employees of the HMO?

To create flexibility in managed care plans, some HMOs and preferred provider organizations have implemented a(n) ____

Which act allows employees to continue health care coverage beyond the benefit termination date?

The identification of disease and the provision of care and treatment.

Medical malpractice insurance is which type of insurance?

Which is the abbreviation for the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000?