IHMO Ch. 3 Final – Flashcards

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question
Which statement is correct regarding the insurance industry?
answer
The insurance industry is among the world's largest businesses.
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Most legal issues of private health insurance claims fall under ______.
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civil law
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When does the physician/patient contract begin?
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When the physician accepts the patient and agrees to treat the patient.
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Most Physician/patient contracts are _____.
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implied
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When a patient carries private medical insurance, the contract for treatment exists between the _______.
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physician and the patient
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An emancipated minor is a person ________.
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younger than the age of 18 who lives independently.
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The contract in a workers' compensation case exists between the ________.
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physician and the insurance company
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In health insurance, the insured is also known as the _____.
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Subscriber, member, and policy holder
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The insured is always the
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individual enrollee or organization protected
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A policy in which the insurer cannot increase premium rates and must renew the policy until the insured reaches the age specified in the contract is a ________ policy.
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noncancelable
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The reason for a coordination of benefits statement in a health insurance policy is to
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prevent duplication or overlapping of payments for the same medical expense.
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Mr. Talili has two medical insurance policies. To prevent duplication of payment for the same medical expense, the policies include a _______ statement.
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coordination of benefits
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In cases of divorce, the decision as to which parent should be responsible for payment of the child's services should be made by the __________.
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court system
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If a child has health insurance coverage from the two parents, according to the birthday law
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the health plan of the person whose birthday (month and day) falls earlier in the calendar year will pay first.
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According to the birthday law, if both the mother and the father have the same birthday, the
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plan of the person who has coverage longer is the primary payer.
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Conditions that existed and were treated before the health insurance policy was issued are called _____.
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preexisting
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An attachment to an insurance policy that excludes certain illnesses or disabilities that would otherwise be covered is referred to as a _______.
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waiver
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What is the correct term used to determine if a procedure is covered and medically necessary?
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preauthorization
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Mrs. Thompett leaves her place of employment, She is eligible to transfer her medical insurance coverage plan from group to an individual contract. This is known as ____ privilege.
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conversion
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Why would conversion from a group policy to an individual policy be advantageous?
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No physician examination is required
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Mr. O was laid off from his job. He is protected under COBRA, which requires his employer to
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extend group health insurance coverage for 18 months.
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What is the minimum number of employees a company must have to meet the criteria of the COBRA for continues medical benefits if an employee is laid off from a company?
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20
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The act created to protect workers and their families so that they can get and maintain health insurance if they change or lose their jobs is called the
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HIPAA
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An organization of physicians, sponsored by a state or local medical association, concerned with the development and deliver of medical services and the cost of health care is known as a
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foundation for medical care
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A type of managed care organization created by the 1982 TEFRA that allows for enrollment of Medicare beneficiaries into managed care plans is a
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competitive medical plan. (CMP)
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A state and federal program for children who are younger than 21 years of age and have special health care needs is
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Maternal and Child Health Programs (MCHP)
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A patient intake sheet is also called a ____.
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patient registration form
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The first document obtained in the initial patient visit is a
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patient information form
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Assignment of benefits is
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the transfer of one's legal right to collect the amount payable under an insurance contract.
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An encounter form may be also known as a
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patient service slip
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The source document for insurance claim data is the
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superbill
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A daily record sheet used to record daily business transactions is called a
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day sheet
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Under HIPAA guidelines, physicians must send all claims electronically if they have _____ full-time employees.
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more than 10
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An insurance claims register facilitates
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a follow-up of insurance claims
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When the physicians services have been submitted to the patient's insurance company by the physician's office, the patient should
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be sent a monthly statement indicating the insurance companyy has been billed
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