Chapters 11, 12, 13, & 14
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| show | PPG
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| A program that offers a combination of HMO-style cost management and PPO-style freedom of choice is a(n) | show 🗑
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| A significant contribution to HMO development was the | show 🗑
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| show | Ross-Loos medical group
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| An organization that gives members freedom of choice among physicians and hospitals and provides a higher level of benefits if the providers listed on the plan are used is called a(n) | show 🗑
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| How are physicians who work for a prepaid group practice model paid? | show 🗑
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| How does an HMO receive payment for the services its physicians provide? | show 🗑
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| show | not employees and are not paid salaries.
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| show | it limits the patients choice of personal physicians
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| show | quality improvement organization
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| A primary care physician who controls patient access to specialists is called a(n) | show 🗑
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| show | 2014
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| show | basic
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| show | managed care organization
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| show | 25
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| show | True
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| show | False
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| If a primary care physician sends a patient to a specialist for consultation and the specialist is not in the managed care plan, the specialist may bill the primary care physician for payment. | show 🗑
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| show | True
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| show | True
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| In certain managed care plans there is an incentive for the gatekeeper to limit patient referrals to specialists. | show 🗑
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| show | True
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| Managed care plans allow laboratory tests to be performed at any facility the patient chooses. | show 🗑
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| show | False
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| show | False
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| A claims assistance professional (CAP) | show 🗑
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| A Medicare prepayment screen | show 🗑
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| show | Medicare-approved charge
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| A program that contracts with CMS to review medical necessity and appropriateness of inpatient medical care is known as a(n) | show 🗑
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| show | Medicare remittance advice document
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| show | $147
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| show | deposit the check and then write to Medicare to notify them of the overpayment
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| show | clinical laboratory tests.
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| show | Federal
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| show | The Centers for Medicare and Medicaid Services.
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| show | limiting charge
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| show | Medigap, Medifill
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| An NPI number issued to a provider by CMS is the acronym for | show 🗑
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| show | B
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| show | 65
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| A Medicare patient with an HMO does not need a supplemental insurance policy. | show 🗑
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| A nonparticipating physician who is not accepting assignment may bill any fee he or she wants. | show 🗑
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| All persons age 65 who meet eligibility requirements for Medicare receive Medicare Part B (outpatient coverage). | show 🗑
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| show | False
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| Benefits of Medigap policies may vary from one state to another. | show 🗑
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| Each Medicare hospital benefit period consists of 60 consecutive days in a hospital or nursing facility. | show 🗑
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| show | True
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| show | True
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| show | True
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| show | True
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| show | handicap needs who require orthopedic treatment or plastic surgery
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| show | expanding Medicaid eligibility requirements
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| If a physician accepts Medicaid patients, the physician must accept | show 🗑
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| In the Medicaid program, Congress authorized vendor payments for medical care, which are payments from the | show 🗑
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| Medicaid eligibility must always be checked for the _____ of service. | show 🗑
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| show | state government with partial federal funding
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| show | the blind, the disabled and the aged 65+
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| Medicaid managed care patient claims should be sent to the | show 🗑
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| State Children's Health Insurance Programs (SCHIPs) | show 🗑
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| show | CMS
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| Medicaid identification cards are usually issued every __________. | show 🗑
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| show | XIX
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| show | reciprocity
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| show | share of cost
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| show | DEFRA
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| A physician may accept or refuse Medicaid patients on the basis of the individual patient and his or her circumstances. | show 🗑
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| show | False
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| All states processing medical claims must bill using the CMS-1500 claim form. | show 🗑
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| Emergency care and pregnancy services are exempt by law from copayment requirements. | show 🗑
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| show | True
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| Home health care is never covered under Medicaid. | show 🗑
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| If a service is totally disallowed by Medicaid, a physician is within legal rights to bill the patient. | show 🗑
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| In some cases the welfare office may grant retroactive eligibility to a patient. | show 🗑
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| It is not possible for a person to be eligible for Medicaid benefits and also have additional group health insurance coverage. | show 🗑
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| It is not possible for an immigrant to have Medicaid coverage. | show 🗑
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| A physician who chooses not to participate in TRICARE bills __________ charge. | show 🗑
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| show | HCF
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| An NAS is a certification | show 🗑
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| show | 1 year at a time
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| show | doctors of medicine, osteopathy and psychologists
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| show | Individual time limits for each item on the claim.
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| Medical care that is cost-shared by both TRICARE Standard and a civilian source is known as _____ care. | show 🗑
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| show | CHAMPVA beneficiaries.
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| show | TRICARE Prime.
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| show | defined by ZIP codes and based on an area of about 40 miles in radius surrounding each USMTF
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| show | NAS
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| A person who has served in the Armed Forces of the United States, especially in time of war, who is no longer in the service and has received an honorable discharge is called a(n) | show 🗑
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| show | 10
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| show | fiscal intermediary
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| Dependents of individuals who have died as a result of service-connected injuries qualify to receive __________ benefits. | show 🗑
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| A certified nurse midwife is an authorized provider of health care for TRICARE beneficiaries. | show 🗑
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| A partnership program permits TRICARE-eligible people to receive inpatient treatment from civilian providers of care in a military hospital. | show 🗑
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| show | True
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| Active duty service members are eligible for TRICARE Extra. | show 🗑
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| show | True
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| show | False
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| show | True
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| show | False
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| show | False
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| show | True
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Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
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To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
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