MBC 103 Final Review (Pictures)

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

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

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

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

Medical malpractice insurance is which type of insurance?

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

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

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

The word embezzle means to (what?)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Which is another name for a health insurance specialist?

Accountable care organizations...

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The IMPACT Act is what?

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

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

Which organization offers the CMRS exam?

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

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

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

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

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

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

This patient record is created for a single medical practice

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

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

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

Which is submitted to the payer requesting reimbursement?

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?

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

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

Which provides coverage for catastrophic or prolonged illnesses and injuries?

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

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

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

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

Which is Latin for “let the master answer?”

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

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

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

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

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

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

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

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

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...