7) Additional Types of Insurance Flashcards Preview

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Flashcards in 7) Additional Types of Insurance Deck (19)
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1
Q

Individuals with Disabilities Education Act (IDEA)

A

Law that mandates education for kids w/disabilities who are 3-21y/o

2
Q

Individualized Education Program (IEP)

A

Written educational plan for a student w/disabilities

3
Q

Describe payment for school-based services

A
  • Health insurance is not on the hook
  • Payment is through the school or school district through taxes
  • Medicaid can cover if student is eligible
4
Q

What are the exceptions to school-based services coverage and how are these covered?

A
  • Injuries at school
  • Sports injuries
    • School insurance will supplement student’s health insurance
5
Q

What does Part C of IDEA support?

A

Early Intervention (birth-3y/o)

6
Q

How is early intervention paid for?

A

Through the child’s individualized family service plan (IFSP)

7
Q

Name some specialized payers

A
  • Guilds/Unions → Provide care for their members
  • Religious Groups
  • Fundraising
  • Charitable Groups → fund US travel for medical care
  • Private organizations
8
Q

Workers Comp

A

State-specific liability health insurance for work-related injuries/conditions

  • Typically excluded from health insurance coverage
  • Some states don’t use CPT codes
  • Some states require participation
9
Q

True or False: There’s multiple ways states to fund workers comp

A

True

10
Q

What state are workers comp claims filed in?

A

The state where the pt got injured

11
Q

True or False: NJ requires employers to have workers comp or self-insurance or they can get in trouble

A

True

12
Q

Describe the workers comp process

A
  • Injured worker files a claim w/their employer
  • Claim/case manager reviews and the claim and approves or denies it
  • Preauth is typically needed
13
Q

Is balance billing allowed for workers comp?

A

Usually not

14
Q

Automobile Liability

A

Covers damages to vehicles and individuals involved in a car accident

  • Some policies don’t pay for injuries (state-specific)
15
Q

What happens if a person lives in a no-fault state?

A

PIP will pay for medical expenses and lost wages for the policyholder and their passengers

  • Ensures that peeps can get care no matter who was at fault
16
Q

Is NJ a no-fault state?

A

Yes

17
Q

Who regulates the NJ Auto Insurance Law

A

The state govt

18
Q

What are the regulations for PIP coding and billing based on the NJ Auto Insurance Law?

A
  • Use CPT codes
  • 21-day notice is required
  • There’s regional fee schedules
  • MD referral is required for PT
  • Max daily allowance for PM&R codes is $105
    • Fees exceed this for complex cases
19
Q

What is used to regulate spine care?

A

Care Paths → Cook book for what kind of care should be done for spine injuries