Introduction To Health Insurance Quiz

The correct answer is the Federal Employees Compensation Act. This act replaced the 1908 Workers Compensation legislation and provided medical care, survivors benefits, and compensation for lost wages to civilian employees of the federal government.

Medicare is the correct answer because it is a government health plan specifically designed to provide healthcare services to Americans who are 65 years old or older. It is a federal program that helps cover medical expenses such as hospital stays, doctor visits, prescription drugs, and preventive services for eligible individuals. Medicaid, CHAMPUS, and TRICARE are also government health plans, but they serve different populations and have different eligibility criteria.

The Federal Employees Compensation Act replaced the 1908 workers compensation legislation and provided civilian employees of the federal government with medical care, survivors benefits, and compensation for lost wages.

The correct answer is "regardless of where the test was performed". The explanation is that the Clinical Laboratory Improvement Act (CLIA) applies to all laboratory testing, not just those conducted at hospitals and large institutions. This means that regardless of where the test is performed, whether it is at a hospital, clinic, or any other healthcare facility, the CLIA standards for quality, accuracy, reliability, and timeliness of patient test results must be followed.

The correct answer is "create better access to health insurance, limit fraud and abuse, and reduce administrative cost." The primary intent of HIPPA legislation is to improve the healthcare system by ensuring that individuals have better access to health insurance coverage, protecting their privacy and security of their health information, reducing fraud and abuse in the healthcare industry, and streamlining administrative processes to make healthcare more efficient and cost-effective.

The correct answer is Baylor University in Dallas, Texas. The Blue Cross policy was first introduced by Baylor University in Dallas, Texas.

Group health care coverage is typically offered by employers to their employees. This type of coverage allows a group of individuals, such as employees of a particular company, to access healthcare services and benefits collectively. Employers often negotiate and provide group health insurance plans to their employees as part of their employee benefits package. This coverage is different from individual health insurance plans that individuals purchase on their own.

Major medical insurance provides coverage for catastrophic or prolonged illness and injuries, incorporating large deductibles and lifetime maximum amounts. This type of insurance is designed to protect individuals from high medical expenses that may arise from serious or long-term health conditions. By offering coverage for catastrophic or prolonged illnesses, major medical insurance ensures that individuals have financial protection in case of unexpected and costly medical events. The inclusion of large deductibles and lifetime maximum amounts helps to manage the overall cost of the insurance plan while still providing coverage for significant medical expenses.

The primary purpose of the patient record is to ensure the continuity of care. This means that the record serves as a comprehensive and accurate documentation of the patient's medical history, treatment plans, medications, and other relevant information. It allows healthcare providers to have a complete understanding of the patient's health status, enabling them to make informed decisions and provide appropriate and consistent care over time. The patient record also facilitates communication and coordination among different healthcare professionals involved in the patient's care, ensuring that there is a seamless transition between different healthcare settings or providers.

The Blue Shield concept grew out of the lumber and mining camps of the Pacific Northwest region at the turn of the century. This region was known for its abundant natural resources and booming industries, which led to the establishment of camps and communities to support the workers. The Blue Shield concept, which aimed to provide healthcare services to these workers, likely emerged in response to the need for medical care and support in these remote and often hazardous environments.

The Hill-Burton Act aimed to modernize hospitals that had become outdated due to lack of investment during the Great Depression and World War II. To receive federal grants, these facilities were obligated to offer services either for free or at reduced rates to patients who were unable to afford healthcare. This provision ensured that healthcare services would be accessible to those in need, even if they couldn't afford to pay for it.

Coinsurance refers to the percentage of the cost of healthcare services that a patient is responsible for paying, while the health plan covers the remaining percentage. In this case, the health plan pays 80% of the cost and the patient pays 20%. Coinsurance is different from copay, which is a fixed amount that a patient pays for specific services, and deductible, which is the amount a patient must pay out of pocket before the health plan starts covering costs. Maximum is not the correct answer as it does not relate to the cost-sharing between the patient and the health plan.

The National Correct Coding Initiative (NCCI) promotes national correct coding methodologies and eliminates improper coding. NCCI edits are developed based on coding conventions defined in current standards of medical and surgical coding practice, input from specialty societies, and analysis of current coding practices. CPT (Current Procedural Terminology) is a coding system used for reporting medical procedures and services. Therefore, CPT is the correct answer as it aligns with the explanation provided.

The correct answer is Franklin Health Assurance Company. This company was the first commercial insurance company in the United States to offer private healthcare coverage for injuries that did not result in death.

In SOAP format, the objective portion of the clinic note is where the provider documents the physical examination. This section includes factual and measurable information about the patient's physical findings, such as vital signs, physical appearance, and any abnormalities or observations made during the examination. It is important for providers to accurately and objectively document this information to ensure effective communication with other healthcare professionals and to provide a comprehensive view of the patient's condition.

In the SOAP format, the subjective portion of the clinic notes is where the provider documents the patient's statements, feelings, and symptoms. This includes any information that the patient shares about their condition, such as their inability to sleep for weeks. The subjective portion is important for understanding the patient's perspective and gathering information about their symptoms and concerns.

The correct answer is "system of checks and balances for labor and management." This answer suggests that third party administrators (TPA's) play a role in ensuring fairness and accountability between labor and management in the administration of health care plans and processing of claims. They act as a neutral party that monitors and oversees the activities of both parties, ensuring that neither takes advantage of the other. This helps to maintain a balanced and fair system for all stakeholders involved.

The correct answer is record linkage. Record linkage refers to the process of connecting or linking different health records of the same patient, which were created at different locations, using a unique patient identifier or identification number. This allows for a comprehensive and consolidated view of the patient's health information, regardless of where it was generated. By linking these records, healthcare providers can have a more complete understanding of the patient's medical history, leading to better decision-making and improved patient care.

The Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) enacted the diagnosis related groups (DRGs) payer system. DRGs are a classification system used by Medicare to categorize patients and determine reimbursement rates based on their diagnoses, procedures, age, and other factors. This system aims to standardize payments for hospital services and promote efficiency in healthcare delivery.

Quality improvement organizations are currently responsible for the utilization and quality control review of health care provided to Medicare beneficiaries. These organizations work to ensure that the care being delivered meets established standards and guidelines. They review the services provided and identify areas for improvement, with the goal of enhancing the overall quality and efficiency of healthcare for Medicare beneficiaries. Peer review organizations, professional standards review organizations, and consumer-driven health plans are not specifically responsible for this task.

The correct answer is subjective, objective, assessment, plan. This is because the components listed in the answer (subjective, objective, assessment, plan) are commonly used in the problem-oriented record (POR). The subjective component includes the patient's complaints and symptoms, while the objective component includes the results of physical examinations and laboratory data. The assessment component involves the healthcare provider's evaluation and diagnosis, and the plan component outlines the intended treatment and management plans for the patient.