Ch. 02 Introduction to Health Insurance

Question 1

ACA

Answer 1

Affordable Care Act (Obamacare) 3/23/2010

Question 2

CHIP

Answer 2

Children’s Health Insurance Program

Question 3

CMS

Answer 3

Centers for Medicare and Medicaid Services

Question 4

CMS-1500 claim

Answer 4

claim submitted for reimbursement of physician office procedures and services; electronic version is ANSI ASC X12N 837P.

Question 5

COBRA

Answer 5

Consolidated Omnibus Budget Reconciliation Act of 1985
allows employees to continue health care coverage beyond the benefit termination date.

Question 6

continuity of care

Answer 6

documenting patient care services so that others who treat the patient have a source of information on which to base additional care and treatment.

Question 7

CPT

Answer 7

Current Procedural Terminology
developed by the American Medical Association.

Question 8

deductible

Answer 8

amount for which the patient is financially responsible before an insurance policy provides coverage.

Question 9

DHHS

Answer 9

Department of Health and Human Services

Question 10

EHR

Answer 10

electronic health record
global concept that includes the collection of patient information documented by a number of providers at different facilities regarding one patient.

Question 11

EIN

Answer 11

Employer Identification Number

Question 12

EMR

Answer 12

electronic medical record,
has a more narrow focus,
considered part of the electronic health record; is created for a single medical practice using vendor software, which assists in provider decision making.

Question 13

group health insurance

Answer 13

traditional health care coverage subsidized by employers and other organizations (labor unions, rural and consumer health cooperatives) whereby part or all of premium costs are paid for and/or discounted group rates are offered to eligible individuals.

Question 14

health care

Answer 14

expands the definition of medical care to include preventive services.

Question 15

health insurance

Answer 15

contract between a policyholder and a third-party payer or government program to reimburse the policyholder for all or a portion of the cost of medically necessary treatment or preventive care by health care professionals.

Question 16

Health Insurance Marketplace

Answer 16

Created by the ACA
allows Americans to purchase health coverage that fits their budget and meets their needs.

Question 17

HIPAA

Answer 17

Health Insurance Portability and Accountability Act of 1996
governs privacy, security, and electronic transactions standards for health care information.

Question 18

HMOs

Answer 18

Health Maintenance Organizations

Question 19

ICD

Answer 19

International Classification of Diseases

Question 20

individual health insurance

Answer 20

private health insurance policy purchased by individuals or families who do not have access to group health insurance coverage; applicants can be denied coverage, and they can also be required to pay higher premiums due to age, gender, and/or pre-existing medical conditions (Aetna).

Question 21

lifetime maximum amount

Answer 21

maximum benefit payable to a health plan participant.

Question 22

Major medical insurance

Answer 22

coverage for catastrophic or prolonged illnesses and injuries.

Question 23

Medicaid

Answer 23

cost-sharing program between the federal and state governments to provide health care services to low-income Americans; originally administered by the Social and Rehabilitation Service (SRS).

Question 24

medical care

Answer 24

includes the identification of disease and the provision of care and treatment as provided by members of the health care team to persons who are sick, injured, or concerned about their health status.

Question 25

medical necessity

Answer 25

the patient’s diagnosis must justify diagnostic and/or therapeutic procedures or services provided.

Question 26

Medicare

Answer 26

reimburses health care services to American over the age of 65.

Question 27

OSHA

Answer 27

Occupational Safety and Health Administration

Question 28

patient record,
medical record

Answer 28

documents health care services provided to a patient;
serves as a medico-legal document and a business record.

Question 29

payer mix

Answer 29

different types of health insurance payments made to providers for patient services.

Question 30

PHR

Answer 30

personal health record
web-based application that allows individuals to maintain and manage their health info in a private, secure, and confidential environment.

Question 31

policyholder

Answer 31

a person who signs a contract with a health insurance company and who, owns the health insurance policy; the policyholder is the insured or enrollee and the policy might include coverage for dependents.

Question 32

preventive services

Answer 32

designed to help individuals avoid problems with health and injuries.

Question 33

problem-oriented record

Answer 33

POR, a systematic method of documentation that consists of four components: database, problem list, initial plan, and progress notes.

Question 34

Public health insurance

Answer 34

federal and state government health programs (Medicare, Medicaid, CHIP, TRICARE) available to eligible individuals.

Question 35

record linkage

Answer 35

allows patient information to be created at different locations according to a unique patient identifier or identification number.

Question 36

Single-payer system

Answer 36

Centralized health care plan adopted by some Western nations (Canada, Great Britain) and funded by taxes. The government pays for each resident’s health care, which is considered a basic social service.

Question 37

SOAP

Answer 37

Subjective, Objective, Assessment, Plan.

Question 38

Socialized medicine

Answer 38

type of single-payer system where the government owns and operates health care facilities and providers (physicians) receive salaries; the VA health care program is a form of socialized medicine.

Question 39

third-party payer

Answer 39

a health insurance company that provides coverage, such as BlueCross BlueShield.

Question 40

TPMS

Answer 40

total practice management software
used to generate the EMR, automating medical practice functions.

Question 41

TRICARE

Answer 41

CHAMPUS Reform Initiative (CRI) resulted in a new health program which includes TRICARE Prime and TRICARE Select.

Question 42

Universal health insurance

Answer 42

goal of providing every individual with access to health coverage, regardless of the system implemented to achieve that goal Obamacare).

Question 43

Usual and Reasonable Payments

Answer 43

based on fees typically charged by providers in a particular region of the country.

Question 44

WHO

Answer 44

World Health Organization

Question 45

benchmarking

Answer 45

practice that allow an entity to measure and compare its own data against that of other agencies/organizations for the purpose of continuous improvement.