Admin Flashcards
When are third party administrators used
To administer services and to pay claims for self-insured group plans
What do physician hospital organizations involve
A major hospital or hospital chain and its physicians
Who mandates workers compensation
The State
What is the goal of workers compensation insurance carriers
Returning the injured worker to the workforce as soon as possible
What is third-party reimbursement
Reimbursement by the policyholder’s insurance company for services performed by health care professionals
What do health maintenance organizations provide
Preventive measures and limits where individuals can receive care
How much do HMOs normally cover in medical costs
Generally 100% as long as care is rendered at an HMO facility.
On what basis do preferred provider organizations pay
Fee for service
What do preferred provider organizations provide
Discounted health care but limits where a person can go for treatment
What is the point of service plan made up of
The structure of an HMO, yet allowing members to go outside the HMO to obtain services
Medicare services which population
Aged and disabled
Medicare services which population
Low incomes and limited resources
What is the billing code for ice?
97010
What is the 5 step approach to creating a clinical question?
Ask, Acquire, Appraise, Apply, Assess
NOCSAE
National Operating Committee on Standards for Athletic
