Financial Advocacy: Commercial Flashcards
Healthcare services or supplies needed to prevent, diagnose or treat an illness, injury, condition, disease or its symptoms and that meet nationally accepted standards of medicine
medically necessary
Which of the following are types of private health insurance coverage?
A. Indemnity or fee for services
B. Managed care
C. Exclusive provider organizations
D. All of the above
D. All of the above.
Federal health insurance program for people who are 65 or older, certain people with disabilities and people with end stage renal disease consisting of Parts A,B,C, and D.
Medicare
How many types of health insurance are there?
A. 6
B. 3
C. 2
D. 9
C. 2 (Private health insurance and Public health insurance)
A term generally used when the Medicare program does not have primary payment responsibility, that is, when another payer/insurance company has the responsibility for paying before Medicare.
Medicare Secondary Payer (MSP)
Process of examining and monitoring all medications taken by a client to determine their compatibility, necessity and safety in order to reduce the adverse drug events and enhance adherence.
medication reconciliation
When the insured receive care from within its provider network and in some instances will incur a co-payment for certain services, they are a part of what type of health insurance plan?
A. HMO
B. PPO
C. Medicare Advantage
D. Restricted Plan
A. HMO
Choosing a PPO means:
A. The insured have to use only in-network services
B. The insured has access to services within a tiered system
C. the insured can see the doctor of their choosing, including specialists
D. None of the above
C. the insured can see the doctor of their choosing, including specialists.
State of emotional, psychological and social well-being that affects how one thinks, feels, acts, makes choices, relates to others, handles stress, realizes own potentioal and contributes to society.
mental health
True or False: Deductibles have risen more than eight times faster than worker’s earnings since 2010.
True
Relationship between an expert and a protege that aims to facilitate the professional development and advancement of the protege to further develop the protoege and to meet the protege’s career goals.
mentoring
True or False: Charges exceeding co-pays and not approved (denied) by the insurer due to medical necessity provisions can be balance billed to the patient.
False
Physiologic measure that expresses the energy cost of physical activities and is defined as the ratio of metabolic rate during a specific physical activity to a reference metabolic rate.
Metabolic Equivalent of Task (MET)
Nationally recognized guidelines that offer integrated, diagnosis-specific references, footnotes and abstracts used to help drive higher quality of care especially in the use of medical resources.
Milliman care guidelines (MCG)
Assessment tool used in skilled nursing facility settings to place residents into resource utilization groups (RUGS) which determine the facility’s payment rate for services provided.
Minimum data set
