What Do You Know About Medicare And Medicaid? Trivia Quiz

An HSA is indeed an account that allows employees to contribute money, typically through payroll deduction, to save for future healthcare expenses. It is a tax-advantaged account that can be used to pay for qualified medical expenses and offers potential tax benefits. Therefore, the statement "A health savings account (HSA) is an account available to employees where they have made monetary contributions, usually through payroll deduction, to help offset future healthcare costs" is true.

Medicare is a federal health insurance program that provides coverage for individuals who are 65 years of age or older, certain younger people with disabilities, and people with End-Stage Renal Disease. It is designed to help these individuals access healthcare services and cover the costs of medical treatments, hospital stays, prescription drugs, and other necessary healthcare expenses. Unlike Medicaid, which is a joint federal and state program for low-income individuals, Medicare primarily focuses on providing health insurance for older adults and individuals with specific medical conditions. HMO and PPO are different types of health insurance plans that may be available to Medicare beneficiaries.

A whistleblower is an individual who exposes unethical or illegal activities taking place within an organization. They do this by sharing this information with the public or individuals in positions of power who can take appropriate action. This act of revealing wrongdoing helps to promote transparency, accountability, and ultimately, positive change within the organization. Therefore, the statement "A whistleblower is a person who reveals wrongdoing within an organization to the public or to those in the position of authority" is true.

Medicaid is a program in the United States that provides medical and health-related services for low-income adults, their children, and individuals with certain disabilities. It is funded by both the state and federal governments and is administered by the states. Medicaid is the largest source of funding for healthcare services for people with limited income.

A primary care physician is responsible for overseeing all aspects of care for a patient. They are the main point of contact for the patient and coordinate their healthcare needs. They provide preventive care, diagnose and treat common illnesses and injuries, and refer the patient to specialists when necessary. The primary care physician plays a crucial role in managing the overall health and well-being of the patient.

The term "Provider" or "Health Care Provider" refers to a broad range of individuals or institutions involved in delivering medical care. This can include doctors, hospitals, health care professionals, and health care facilities. These providers play a crucial role in offering primary care, specialized care, and hospital-based care to patients. They are responsible for diagnosing illnesses, prescribing treatments, and ensuring the overall well-being of individuals seeking medical assistance. Therefore, the term "Provider" or "Health Care Provider" encompasses all these entities involved in delivering medical services.

A PPO (Preferred Provider Organization) is a type of managed care plan where insured individuals receive full coverage at minimal cost when they use in-network providers within their health care plan. However, they also have the option to receive services from out-of-network providers, although this comes at a higher cost.

The correct answer is Medicare Explanation of Benefits (EOMB). This form or document is sent by Medicare to provide an explanation of healthcare services that have been paid for by your Medicare benefits. It outlines the services received, the amount paid by Medicare, and any remaining balance that may be owed by the patient. The EOMB helps individuals understand the coverage and payment details of their Medicare benefits.

The correct answer is NPI. NPI stands for National Provider Identifier, which is a unique, government-issued identifier mandated by HIPAA (Health Insurance Portability and Accountability Act). It is assigned to healthcare providers to identify them as the provider of service to the patient.

A participating provider refers to a professional who has met the necessary requirements and entered into a contractual agreement with a third-party payer. This agreement allows the provider to offer services to members of the payer's network on a predetermined basis. The provider has successfully completed the credentialing process and has been accepted by the third-party payer as a participating provider.

The correct answer is ICD-10-CM. The explanation is that ICD-10-CM is a revised classification system used by the World Health Organization to report morbidity and mortality information. It is projected to be implemented in the US by October 1, 2014. The codes in ICD-10-CM are specific for diseases, injuries, and signs and symptoms.

HMO stands for Health Maintenance Organization, which is a type of managed care plan that typically only covers care from providers within its network. Members of an HMO are required to choose a primary care physician (PCP) who will coordinate their healthcare and refer them to specialists if needed. This means that HMO members have limited flexibility in choosing their healthcare providers compared to other types of plans like PPOs (Preferred Provider Organizations) or HSAs (Health Savings Accounts).

The correct answer is PHI. PHI stands for Protected Health Information, which refers to any information that can be used to identify a patient, such as their name, date of birth, address, phone number, or account number. This information is protected under HIPAA (Health Insurance Portability and Accountability Act) regulations to ensure patient privacy and confidentiality.

Prior Authorization or Preauthorization is the correct answer because it refers to the process where a doctor or provider must obtain special permission from the private health plan or Medicare private drug plan before prescribing a service or medication. This is done to ensure that the service or medication is medically necessary and appropriate, and to control costs by preventing unnecessary or inappropriate treatments. Without prior authorization, the service or medication may not be covered by the plan.

The correct answer is CPT Code. CPT stands for Current Procedural Terminology, which is a list of codes used by healthcare providers to report medical procedures and services. It is published and updated annually by the American Medical Association. CPT codes are used for billing and reimbursement purposes and provide a standardized way to communicate the services provided to patients.

The correct answer is Centers for Medicare & Medicaid Services, Centers for Medicare and Medicaid Services, CMS. The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the US Department of Health and Human Services. It is responsible for administering the Medicare program, which provides health insurance for individuals aged 65 and older, as well as certain younger individuals with disabilities. CMS also works in partnership with state governments to administer Medicaid, the State Children's Health Insurance Program (SCHIP), and health insurance portability standards.

The Children's Health Insurance Program provides health coverage to nearly 8 million children in families with incomes too high to qualify for Medicaid, but who can't afford private coverage.

HIPAA actually stands for the Health Insurance Portability and Accountability Act, not Privacy and Accountability Act. This legislation was enacted in 1996 to protect the privacy and security of individuals' health information and to ensure its portability when changing jobs or health insurance providers.

The Rural Health Clinics program is intended to increase primary care services for Medicaid and Medicare patients in rural communities. This program can be public, private, or non-profit. The main advantage of the program is that it offers enhanced reimbursement rates for providing Medicaid and Medicare services in rural areas.

Private insurance refers to insurance coverage that is provided by either a for-profit or not-for-profit company, as opposed to being provided by the federal or state government. This type of insurance is typically purchased by individuals or employers to protect against financial losses in the event of certain risks or emergencies. Private insurance plans may offer a range of coverage options and benefits, and individuals or employers usually pay premiums to maintain their coverage. Private insurance allows individuals to have more control and choice over their insurance options, but it also means that the coverage and costs may vary depending on the specific plan and provider.

A third-party payer is a term used to describe a company or organization that is responsible for paying for healthcare services provided to individuals. This can include insurance companies, government programs, or employers who provide health insurance coverage to their employees. The third-party payer is distinct from the patient and the healthcare provider, as they are the ones responsible for financing the healthcare services received by the patient.

The patient classification system used by hospitals to bill and be paid by third-party payers is called Diagnostic Related Group (DRG). This system categorizes patients into groups based on their diagnoses, procedures, age, and other factors. It helps hospitals determine the appropriate reimbursement for each patient based on the resources required to treat their specific condition. DRG is widely used in healthcare to ensure fair and accurate billing practices.

An Accountable Care Organization (ACO) is a group of healthcare providers who work together to provide coordinated care and chronic disease management to patients. The organization's payment is tied to achieving health care quality goals and outcomes that result in cost savings. This means that the ACO is financially incentivized to improve the quality of care patients receive while also reducing healthcare costs. ACOs aim to improve patient outcomes, enhance patient satisfaction, and promote cost-effective care delivery.

A superbill is a document that contains important information about a healthcare professional, such as their name, address, registration, and licensing/certification. It also includes codes and charges for the services provided. The term "superbill" is sometimes written as "super bill," but both variations refer to the same document.

The correct answer is Patient-Centered Medical Home (PCMH). The PCMH model aims to improve the physician-patient relationship by shifting from a focus on treating individual illnesses to providing coordinated and comprehensive care. In this model, a physician-led care team takes responsibility for addressing all of the patient's healthcare needs and coordinating care with other qualified physicians when necessary. PCMH emphasizes a long-term healing relationship between the patient and the care team.

Bundled payment is described as a "middle ground" between fee for service reimbursement and capitation. In fee for service, providers are paid for each service rendered to a patient, while in capitation, providers are paid a "lump sum" per patient regardless of the number of services provided. Bundled payment combines aspects of both models by grouping together related services and paying a fixed amount for the entire bundle of care. This encourages coordination and efficiency in healthcare delivery while still providing incentives for high-quality care.

A non-participating provider refers to a professional provider who has not signed a participating provider agreement with a third-party payer. This means that they are considered out-of-network, and patients may have to pay higher out-of-pocket costs when receiving services from them. Non-participating providers do not have a contract with the payer, so they may charge higher fees or have different reimbursement rates. Patients should check with their insurance plan to understand the coverage and costs associated with seeing a non-participating provider.