Learning Goal: I’m working on a health & medical test / quiz prep and need suppo

Learning Goal: I’m working on a health & medical test / quiz prep and need support to help me learn.Chapter 13: BlueCross BlueShield1. The forerunner of what is known today as the BlueCross plan began 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 exchange for a $6 annual premium. This was considered a __________ plan.a. postpaidb. prepaidc. retrospectived. traditional2. BlueShield plans were created as the result of a resolution passed by the House of Delegates at an American Medical Association meeting in 1938. This resolution supported the concept of __________ health insurance that would encourage physicians to cooperate with prepaid health care plans.a. commercialb. mandatoryc. profitd. voluntary3. Nonprofit corporations are charitable, educational, civic, or humanitarian organizations whose profits are __________.a. distributed to shareholders and officersb. paid to the federal government as taxesc. returned to the nonprofit corporationd. sent to beneficiaries who paid premiums4. Participating providers contract to participate in a BCBS plan’s preferred provider network (PPN), which is a program that requires providers to adhere to __________ care provisions.a. hospitalb. managedc. prospectived. retrospective5. BCBS fee-for-service __________ coverage includes additional benefits, such as office visits, physical and occupational therapy, and mental health encounters.a. basicb. contractualc. major medicald. traditional6. The BCBS special accidental injury rider covers nonsurgical care sought and rendered within 24 to 72 hours of the accidental injury, depending on plan benefits. Surgical care is subject to any established contract __________ plan deductibles and copayments.a. basicb. major medical7. BCBS indemnity coverage offers choice and flexibility to subscribers who want to receive a full range of benefits along with the __________.a. freedom to use any licensed health care providerb. option to use network-based health care providersc. requirement of obtaining referrals to providersd. restriction of selecting a primary care provider8. The BCBS outpatient pretreatment authorization plan (OPAP) requires preauthorization of outpatient physical, occupational, and speech therapy services. Other terms for OPAP include precertification and __________ authorization.a. point-of-serviceb. preferredc. prospectived. retrospective9. BCBS has a mandatory second surgical opinion (SSO) requirement necessary when a patient is considering elective, nonemergency surgical care. The initial surgical recommendation must be made by a physician qualified to perform the anticipated surgery. If a second surgical opinion is not obtained prior to surgery, the patient’s out-of-pocket expenses may be __________.a. eliminatedb. increasedc. reducedd. waived10. FEP cards contain the phrase __________ under the BCBS trademark.a. BCBS Supplemental Planb. Federal Employee Programc. Government-Wide Service Benefit Pland. Healthcare Anywhere11. BCBS Healthcare Anywhere coverage allows members of the independently owned and operated BCBS plans to have access to health care benefits throughout the __________, depending on their home plan benefits.a. preferred provider networkb. state in which they residec. United States onlyd. United States and world12. The Away From Home Care Program allows participating BCBS plan members who are temporarily residing outside of their home HMO service area for at least 90 days to temporarily enroll with a local __________.a. health maintenance organizationb. managed care companyc. nonparticipating providerd. out-of-network providerChapter 14: Medicare13. Which program pays for inpatient hospital critical care access, skilled nursing facility stays, hospice care, and some home health care?a. Medicare Part Ab. Medicare Part Bc. Medicare Part Cd. Medicare Part D14. Which program includes managed care and private fee-for-service plans that provide contracted care to Medicare patients?a. Medicare Part Ab. Medicare Part Bc. Medicare Part Cd. Medicare Part D15. Which insurance claim is submitted to receive reimbursement under Medicare Part A?a. CMS-1500b. CMS-1500 or UB-04c. CMS-1500 and UB-04d. UB-0416. Which insurance claim is submitted to receive reimbursement under Medicare Part C?a. CMS-1500b. CMS-1500 or UB-04c. UB-92d. UB-0417. An initial enrollment period (IEP) that provides an opportunity for the individual to enroll in Medicare Part A and/or Part B is for a period of __________ months.a. 3b. 6c. 7d. 918. Mary Smith is working full time and enrolled in Medicare Part A at age 65. She decided not to enroll in Medicare Part B at that time because her employer group health insurance coverage reimburses for physician and other outpatient encounters. Mary is eligible to enroll in Medicare Part B anytime during a(n) __________ enrollment period, which is a set time when individuals can sign up for Medicare Part B if they did not enroll when they applied for Medicare Part A.a. beneficiaryb. generalc. initiald. special19. Which program helps low-income individuals by requiring states to pay their Medicare Part B premiums?a. qualified Medicare beneficiary programb. qualified disabled working individualc. Programs of All-Inclusive Care for the Elderlyd. specified low-income Medicare beneficiary20. A Medicare benefit period begins with the first day of hospitalization and ends when the patient has been out of the hospital for __________ consecutive days.a. 10b. 30c. 60d. 9021. Which is an autonomous, centrally administered program of coordinated inpatient and outpatient palliative (relief of symptoms) services for terminally ill patients and their families?a. home healthb. hospicec. hospitald. respite22. Private fee-for-service (PFFS) plans are offered by private insurance companies in some regions of the country, and Medicare pays a pre-established amount of money each month to the insurance company, which decides how much it will pay for services. Such plans reimburse providers on a fee-for-service basis and are authorized to charge enrollees up to __________ percent of the plan’s payment schedule.a. 50b. 80c. 100d. 11523. Which is a type of HMO that works in much the same way and has some of the same rules as a Medicare Advantage Plan, except that the individual receives health care from a non-network provider, and the original Medicare plan covers the services? The individual pays Medicare Part A and Part B coinsurance and deductibles.a. Medicare Advantageb. Medicare Cost Planc. Medicare Supplementary Insuranced. Medicare SELECT24. Medicare __________ is a type of Medigap insurance that requires enrollees to use a network of providers to receive full benefits, which may result in lower premiums for enrollees.a. PACEb. PLUSc. SELECTd. SUPPLEMENT25. An advance beneficiary notice of noncoverage (ABN) is a written document provided to a Medicare beneficiary by a supplier, physician, or provider, and the ABN must be presented to the patient __________.a. after Medicare has denied payment for the serviceb. at least one month before providing the servicec. on the day the service or treatment is providedd. prior to providing the service or treatmentChapter 15: Medicaid26. In 1965 Congress passed Title 19 of the Social Security Act, establishing a federally mandated, __________-administered medical assistance program for individuals with incomes below the federal poverty level.a. federalb. countyc. municipald. state27. Which describes annual income guidelines established by the federal government?a. federal poverty levelb. medically needy Medicaid programc. Supplemental Security Incomed. Temporary Assistance for Needy Families28. Which is the special group that requires states to pay Medicare premiums, deductibles, and coinsurance amounts for individuals whose income is at or below 100 percent of the federal poverty level and whose resources are at or below twice the standard allowed under SSI?a. qualified Medicare beneficiariesb. qualifying individualsc. qualified working disabled individualsd. specified low-income Medicare beneficiaries29. Which is the special group that requires states to pay Medicare Part A premiums for certain disabled individuals who lose Medicare coverage because of work?a. qualified Medicare beneficiariesb. qualifying individualsc. qualified working disabled individualsd. specified low-income Medicare beneficiaries30. The State Children’s Health Insurance Program (SCHIP) was implemented in accordance with the Balanced Budget Act (BBA) to allow states to create or expand existing insurance programs, providing more federal funds to states for the purpose of expanding __________ eligibility to include a greater number of currently uninsured children.a. commercial insuranceb. group health insurancec. Medicaidd. Medicare31. The Medicare Catastrophic Coverage Act of 1988 implemented Spousal Impoverishment Protection Legislation in 1989 to prevent married couples from being required to spend down income and other liquid assets (cash and property) before one of the partners could be declared eligible for Medicaid coverage for nursing facility care. The spouse residing at home is called the __________ spouse.a. communityb. eligiblec. partnerd. surviving
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