Exam 2 Quizzes Flashcards
The largest employer-sponsered health program in the United States is
Federal Employees Health Benefits Program
T or F? A carve out may be used by an employer to omit a specific plan benefit that is usually covered by a health plan
Correct Answer is True
T or F? Elective surgery is not reimbursed because it is not medically necessary
Correct Answer is False
T or F? Claims for private payers are sent first to patients who then send them to the employer.
Correct Answer is False
T or F? If the participation contract states that copayments apply; the payer subtrats the patient’s copayment from the providers’s reimbursement
Correct Answer is True
Undera a capitated HMO plan the physician practice receives
a monthly enrollment list
T or F? A consumer driven plan involves a high-deductible health plan with a funding option such as a health savings account
Correct Answer is True
What document is researched to uncover the rules for private payers’ definitions of insurance-related terms?
Participation contract
The portability of health insurance is govered by which low
HIPAA and COBRA
Providers who participate in a PPO are paid
a discounted fee for service
Under the Medicare Part B traditional fee for service plan; medicare pays ?% of the allowed charges
eighty
Medicaid identification cards must be checked for eligibility
every time the patient receives services
T or F? Individuals who are employed are ineleigible for medicaid
Correct Answer is False
T or F? Medicaid is know as the payer of last resort because an individula must exhaust all other resoures before medicaid pays for healthcare
Correct Answer is False
Individuals apply for Medicaid by contacting
Department of Health and Human services or local Income Maintainence Office
T or F? Medicare is the secodary payer for all beneficaries over age sixty five and working
Correct Answer is False
Medicare part D covers
prescription drugs
T or F? An ABN should be signed by the patient when the provider has reason to think that the services will not be covered by Medicare due to lack of medical necessity
Correct Answer is True
Medicare Part A covers
hospital services
T or F? A carve out may be used by an employer to omit a specific plan benefit that is usually covered by a health plan
Correct Answer is False
T or ? Workers’ Compensation insurance does not cover injuries tin the company parking lot or cafeteria
Correct Answer is False
An employee who believes the work environoment to be dangerous may file a complaint with the
Occupational Safety and Health Administration
T or F? Individuals classified as permanently disabled receive compensation for lost wages and paid medical treatmenet for the work related illness or injury
Correct Answer is True
? Provides workers’ compensation insurance coverage to employees of the federal government
Federal Employee’s Compensation Act
T or F? A physician who treats a patient covered by workers’ compensation insurance may not charge the patient for any amount of the medical expense
Correct Answer is True
? Is a denial of employee liability issued by the Workers’ Compensation insurance carrier
Notice of contest
T or F? Occupational illness that develop over time are generally not covered by Workers’ compensation insurance
Correct Answer is False
T or F? Most states require corporaitons that meet established financial standards to obtain authorization to become self insured against Workers’ Compentation claims
Correct Answer is True
T or F? The Federal Employees’ Compensation Act (FECA) was created to protect workers from health and safety risks while on the job
Correct Answer is False
Vocational rehab programs provide ? For individuals with job related disabilities
training in a different job
