FREE AND STUDY GAMES ABOUT CH13 HIT EXAM

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FREE AND STUDY GAMES ABOUT CH13 HIT EXAM

QUESTIONS

Actual Qs and Ans Expert-Verified Explanation

This Exam contains:

-Guarantee passing score -31 Questions and Answers -format set of multiple-choice -Expert-Verified Explanation

Question 1: Blue Cross Blue Shield (BCBS)

Answer:

Joint venture between Blue Cross and Blue Shield in which the corporations shared one building and computer services but maintained separate corporate identities

Question 2: member

Answer:

Subscriber

Question 3: outpatient pretreatment authorization plan (OPAP)

Answer:

Plan that requires preauthorization of outpatient physical, occupational, and speech therapy services.Also called prospective authorization or precertification.

Question 4: prepaid health plan

Answer:

Contract between an employer and a health care facility or physician under which specified medical services are performed for predetermined fees that are paid monthly or yearly

Question 5: coordinated home health and hospice care

Answer:

System that allows patients to elect alternatives to acute care settings

Question 6: American Hospital Association (AHA)

Answer:

National organization that represents and serves all types of hospitals, health care networks, and their patients and communities. Began in 1939 as the accreditation agency for new prepaid hospitalization plans

Question 7: nonprofit corporation

Answer:

Charitable, educational, civic, or humanitarian organization whose profits are returned to the program of the corporation rather than distributed to shareholders and officers of the corporation

Question 8: Federal Employee Program (FEP)

Answer:

Same as (FEHBP)

Question 9: preferred provider network (PPN)

Answer:

Program that requires providers to adhere to managed care provision

Question 10: BCBS major medical (MM) coverage

Answer:

Coverage provided by Blue Cross and Blue Shield (BCBS) for services in addition to basic coverage, which are office visits, outpatient nonsurgical treatment, physical and occupational therapy, purchase of durable medical equipment (DME), mental health vis

Question 11: precertification

Answer:

Same as (OPAP)

Question 12: member hospitals

Answer:

Hospitals that have signed a contract to provide services for special rates

Question 13: for-profit corporation

Answer:

Entity that pays taxes on profits generated by the corporation's for-profit enterprises and pays dividends to shareholders on after-tax profits

Question 14: Away from Home Care® Program

Answer:

Organization that provides continuous Blue Cross and Blue Shield (BCBS) health care coverage for subscribers who will be out of their service areas for more than 90 consecutive days

Question 15: prospective authorization

Answer:

Same as (OPAP)

Question 16: Government-Wide Service Benefit Plan

Answer:

Phrase printed below the BCBS trademark on FEP insurance cards to indicate that the enrollee has federal employer-sponsored health benefits.

Question 17: medical emergency care rider

Answer:

Verbiage that covers immediate treatment sought and received for sudden, severe, and unexpected conditions that, if untreated, would place the patient's health in permanent jeopardy or cause permanent impairment or dysfunction of an organ or a body part

Question 18: Blue Shield (BS)

Answer:

Entity that incorporated a concept of voluntary health insurance that encouraged physicians to cooperate with prepaid health plans. Began as a resolution passed by the House of Delegates at an American Medical Association (AMA) meeting in 1938.

Question 19: rider

Answer:

Special contract clause stipulating additional coverage over and above the standard contract

Question 20: usual, customary, and reasonable (UCR)

Answer:

Amount providers commonly charge for a medical service in a geographic region. Helps establish allowable rates

Question 21: BlueWorldwide Expat

Answer:

Provides global medical coverage for active employees and their dependents who spend more than 6 months outside of the United States.

Question 22: Federal Employee Health Benefits Program (FEHBP)

Answer:

Employer-sponsored health benefits program established by an act of Congress in 1959 that now provides benefits to more than 9 million federal enrollees and dependents through contracts with about 300 insurance carriers. Also called the Federal Employee P

Question 23: BCBS basic coverage

Answer:

Coverage provided by Blue Cross and Blue Shield (BCBS) for hospitalization, diagnostic laboratory services, X-rays, surgical fees, assistant surgeon fees, obstetric care, intensive care, newborn care, and chemotherapy for cancer.

Question 24: Blue Cross (BC)

Answer:

Insurance plan created in 1929 when Baylor University Hospital in Dallas, Texas, approached teachers in the Dallas school district with a plan that would guarantee up to 21 days of hospitalization per year for subscribers and each of their dependents in e

Question 25: service location

Answer:

Where the patient was seen.