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Coding
Intro
| Question | Answer |
|---|---|
| A method of controlling healthcare costs and quality of care by reviewing the appropriateness and necessity of care provided to patients prior to the admin of care is | Utilization management |
| The utilization management (or utilization review) is a method of controlling healthcare providers and quality of care by reviewing the appropriateness and necessity of care provided to patients prior to the administration of care. | False |
| Preventive services are designed to help individuals avoid health and injury problems | True |
| Case management involves the development of patient care plans for the coordination and provision of care for complicated cases in a cost-effective manner | True |
| An insurance company does not guarantee payment to the insured for an unforeseen event | False |
| A network provider is a physician or healthcare facility under contract to the managed care plan | True |
| A copayment is a provision in an insurance policy that requires the policyholder or patient to pay a specified dollar amount to a healthcare provider for each visit or medical service received. | True |
| type of insurance provides coverage for catastrophic or prolonged illness and injuries | Major medical insurance |
| The problem-oriented record (POR) is a systematic method of documentation that consists of | Data base, progress note, an initial plan |
| The Occupational Safety and Health Administration Act of 1970 was designed to | Protect all employees against injures in the workplace |
| The healthcare plan that reimburses providers for individual healthcare services provided is a | Fee-for-service plan |
| The first Blue Shield plan was founded in | California |
| Prior to scheduling elective surgery, managed care plans often require | A second surgical opinion |
| Preventive services | May result in the early detection of health problems, allow treatment options that are less dramatic and less expensive |
| Managed care plan enrollees receive care from | Their primary care provider |
| Health insurance is available to | Individuals who participate in individual health plans, participants of prepaid health plan, individuals who participate in group health plans |
| Healthcare coverage available through employers and other organizations in which employers usually pay part or all of the premium costs is | Group health insurance |
| Consumer-directed health plans provide incentives for controlling healthcare expenses and give individuals a(n) ____ regarding traditional health insurance and managed | Alternative |
| A plan offered either by a single insurance policy or as a joint venture by two or more insurance carriers and which provides subscribers or employees with a choice of HMO, PPO, or traditional health plan is a | triple option plan, cafeteria plan, flexible benefit plan |
| A network of physicians and hospitals that have joined together to contract with insurance companies to provide health care to subscribers for a discounted fee is a | Preferred provider organization |
Created by:
AdriRobi97