TERMS AND ABBREVIATIONS
FEDERAL INSURANCE CONCEPTS
CLAUSES AND LAWS
NEED TO KNOW
FRUIT SALAD
100
What does PCP stand for?
What is Primary Care Provider
100
What is Title XIX coverage and who does it cover?
What is Title XIX of the SSA of 1965 is Medicaid and provides healthcare services to low-income Americans.
100
What is the gag clause?
What is a doctor not being able to tell the patients all of their options.
100
ICD-9-CM stands for?
What is International Classification of Diseases, 9th Revision, Clinical Modification
100
What does CPT stand for?
What is Current Procedural Terminology
200
____ is a voluntary process that a healthcare facility or organization (e.g., hospital or managed care plan) undergoes to demonstrate that it has met standards beyond those required by law.
What is Accreditation
200
What is Title XVIII coverage and who does it cover?
What is Title XVIII of the SSA of 1965 is Medicare and provides health care to Americans over the age of 65.
200
TRICARE is for?
What is active duty troops
200
Accurate coding of diagnoses, procedures, and services rendered to the patient allows a medical practice to
What is facilitate analysis of the practice’s patient base for improvement and efficiency, communicate diagnostic and treatment data to insurance plans for maximum recovery of benefits.
200
Healthcare coverage available through employers and other organizations in which employers usually pay part or all of the premium costs is
What is group health insurance.
300
What does NCCI stand for?
What is national correct coding inititive
300
The Medicare contracting reform (MCR) initiative was established to integrate the administration of?
What is Medicare Parts A and B.
300
If the insurance plan has a hold harmless clause, it means
What is the patient is not responsible for paying what the insurance plan denies.
300
Which type of insurance provides coverage for catastrophic or prolonged illness and injuries?
What is major medical insurance
300
What involves linking every procedure or service code reported on the claim to a condition code that justifies the necessity of performing that procedure or service?
What is medical necessity
400
what is meant by respondeat superior.
What is Respondeat superior means a healthcare facility (or physician) that employs health insurance specialists is legally responsible for employees’ actions performed within the context of their employment.
400
In what year did HCFA (now called CMS) require providers to use the HCFA-1500 (now called the CMS-1500) to submit Medicare claims?
What is 1984
400
This act amended the Public Health Service Act to establish an Office of National Coordinator for Health Information Technology with HHS to improve healthcare quality, safety, and efficiency.
What is HITECH
400
Prior to scheduling elective surgery, managed care plans often require?
What is a second surgical opinion.
400
What is the role of the primary care provider (PCP)?
What is A PCP is responsible for supervising and coordinating healthcare services for enrollees and approves referrals to specialists and inpatient hospital admissions.
500
RBRVS is an abbreviation for
What is Resource-Based Relative Value Scale
500
The CHAMPUS Reform Initiative (CRI) of 1988 resulted in a new program called TRICARE, which includes three options?
What is standar, prime, extra
500
The ______ was created to promote correct coding methodologies and to eliminate improper coding on a national basis.
What is NCCI
500
What are usual and reasonable payments based on?
What is Usual and reasonable payments are based on fees typically charged by providers based on speciality within a particular region of the country.
500
Which act focuses on private health insurance reform to provide better coverage for individuals with pre-existing conditions, improve prescription drug coverage under Medicare, and extend the life of the Medicare Trust Fund by at least 12 years?
What is PPACA
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