Ch 6: Review Test Flashcards
New and Traditional Reimbursement Models
What type of health insurance offers the best choice of physicians and hospitals, lets patients choose any provider they want, and allows them to change providers at any time?
Indemnity or Fee-for-Service plan
Who is considered a third-party payer?
Commercial insurance companies
Group insurance is a contract between ____ and ____?
A contract between an insurance company and an employer
People who were covered under an employer-sponsored group plan before the enforcement of the Affordable Care Act can usually keep their group coverage as long as the plan meets what rule?
Minimum essential coverage (MEC) rule
What is the best type of healthcare plan?
No one type is universally best
What are three standard patient costs associated with healthcare plans?
- A periodic payment (premium)
- A yearly deductible
- Per-visit coinsurance
A comprehensive listing of medical charges is commonly referred to as what?
Fee schedule
For Americans today, accessibility to healthcare is viewed as what?
A right
When the fee charged by a provider falls within the parameters of the fee commonly charged for that particular service within a specific geographical area, is is said to be ____?
Reasonable and customary
A provider who signs a contractual arrangement with a third-party insurance contractor and agrees to accept the amount paid by the carrier as payment in full is referred to as what?
Participating provider (PAR)
What government health insurance program provides coverage for its own civilian employees?
Federal Employees Health Benefits (FEHB) Program
When the employer - not an insurance company - is responsible for the cost of its employees’ medical services, the employer has a ____?
Self-insured program
What federal law is designed to protect the rights of beneficiaries of employee health plans offered by employers and sets minimum standards for pension plans in private industry?
Employee Retirement Income Security Act (ERISA)
A person or organization that processes claims and performs other contractual administrative services is commonly referred to as a ____?
Third-party administrator (TPA)
What legislation included a mandate that insurance companies must cover certain preventative services for those who purchased or joined a new plan on or after September 23, 2010, without charging out-of-pocket coast?
Patient Protection And Affordable Care Act
