Exam 2 Flashcards
True/false: A 35 year old With congestive heart failure and on medical disability would be eligible for Medicare part A
True
A corporate integrity agreement is comprehensive and last __________ years
A. 5
B. 3
C. 1
D. 2
5
Largest civilian agency in the federal government
Office of Audit Services
Operates the OIG hotline
Office of Investigations
Protect the integrity of the Department of Health and human services and its beneficiaries
Office of Inspector General
Focuses on customer satisfaction and information technology
Office of Management and Policy
Overseas the state Medicaid fraud control units
Office of Evaluation and Inspections
Provide return to work physical exams
Industrial/occupational health clinic
Serves as the license to operate for an independent practice physician
State medical license
Non RN working under the supervision of a MD
Physician Assistant
Not owned or operated by or integrated with a hospital
Freestanding Ambulatory Center
Employee has money deducted from payroll and placed in an account, if unused at the end of the year it is forfeited
Flexible spending account
Voluntary accreditation for freestanding ambulatory care facilities
AAAHC
Must be performed when Patient has more than one insurance policy for health care coverage
Coordination of benefits
Employee makes contributions through payroll and the employer matches
Health savings account
Clinic located on a college campus
University health center
Located in underserved areas where patients otherwise would not receive services
Rural health centers
Manages healthcare effectiveness data and information sets
National committee for quality assurance
Evaluates proficiency of laboratory staff
CLIA
Payment of a fixed dollar amount for each covered person
Capitation
Flat rate based on services provided
Fee schedule
Employer funds and account for the employee
Health reimbursement arrangement
True/False: Patients who have Medicare part A coverage automatically receives part B coverage
False
True/False: Payment of a civilian monetary penalty does not qualify as an admission of guilt and therefore keeps the facility off the exclusion list in certain circumstances
True
Which of the following are characteristics of a managed care organization?
A. Organized system for providing health care in a geographic region
B. All
C. Enrolled members pay a monthly premium
D. Provides incentives for preventative care
B. All
Inpatient physical medicine and rehabilitation
Medicare Part A
Hospice
Medicare Part A
Skilled nursing rehabilitation
Medicare Part A
Physician visits during hospitalization
Medicare Part B
MD office visits
Medicare Part B
Outpatient laboratory and radiology diagnostics
Medicare Part B
Ambulance services
Medicare Part B
Durable medical equipment
Medicare Part B
Long term acute care
Medicare Part A
Inpatient acute care
Medicare Part A
Documentation required in an ambulatory surgery record outlining all the risks in the ________
Informed surgical consent
True/False: Managed care organizations do not monitor the documentation of providers, so licensure and certification are all that is required to join
False
Providers usually purchase stop loss insurance
Independent practice association model
Contracts do not allow for treatment outside of the HMO
Staff model
Health care providers are employed by the multi-specialty physician practice and not the HMO
Group model
Enrolled members selects coverage based on how much out of pocket they are willing to pay
Point of service plan
Enrolled members agree to provide services at a discounted rate to members/subscribers/dependents
Preferred provider organization
No incentive for over utilization of services by MD because profits go to the HMO
Staff model
Covered over a large rural and geographic area
Network model
Contracts with more than one facility and physician group
Network model
Phase of the patient encounter where all the demographic information is obtained is during _________.
Registration
True/False: MD offices utilize a problem list which details only active problems
False
