MEDICAL CODING & BILLING, BLUE CROSS/BLUE SHIELD, CHAPTER 13 EXAM STUDY GUIDE WITH COMPLETE

MEDICAL CODING & BILLING, BLUE CROSS/BLUE SHIELD, CHAPTER 13 EXAM STUDY GUIDE WITH COMPLETE THE FORERUNNER OF WHAT IS KNOWN TODAY AS THE BLUE CROSS PLAN BEGAN IN 1929 WHEN BAYLOR UNVERSITY HOSPITAL IN DALLAS, TEXAS APPROACHED TEACHERS IN THE DALLAS SCHOOL DISTRICT WITH A PLAN THAT WOULD GUARANTEE UP TO 21 DAYS OF HOSPITALIZATIONS PER YEAR FOR SUBSCRIERS AND EACH O THEIR DEPENDENTS, IN EXCHANGE FOR A $6 ANNUAL PREMIUMS. THIS WAS CONSIDERED A _____PLAN. - Answer️️ - PREPAID BY 1932 SOME PLANS MODIFIED THE PREPAID PLAND CONCEPT AND ORGAINZATION COMMUNITY WIDE PROGRAMS THAT ALLOWED THE SUBSCRIBER TO BE HOSPITALIZED IN ONE OF SEVERAL MEMBER HOSPITALS IN ACCORDANCE WITH SIGNED CONTRACTS TO PROVIDE SERVICES______ - Answer️️ -FOR NEGOTIATED SPECIAL RATES BLUE CROSS BLUE SHEILD PLANS WERE CREATED AS THE RESULT OF A RESOULUTION 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. - Answer️️ -VOLUNTARY ©SOPHIABENNETT EXAM SOLUTIONS_2024/2025 Monday, September 2, 2024 12:59 PM Page | 2 BLUE CROSS BLUE SHEILD PLANS ORIGINALLY COVERED ONLY HOSPITAL BILLS AND BLUE SHEILD PLANS COVERED FEES FOR PHYSICIAN SERVICES, AND THERE WAS CLOSE CORPORATION BETWEEN THE PLANS THAT RESULTED IN JOINT VENTURES WHERE THE TWO CORPORATIONS WERE HOUSED IN ONE BUILDING. IN THESE JOINT VENTURES BLUE CROSS BLUE SHEILD, BCBS. - Answer️️ -SHARED ON BUILDING AND COMPUTER SERVICESBUT MAINTAINED SEPARATE CORPORATE IDENTITIES. NON PROFIT CORPORATIONS ARE CHARITABLE, EDUCATIONAL, CIVIC, OR HUMANITARIAN ORGANIZATIONS WHOSE PROFITS ARE__________ - Answer️️ - RETURNED TO THE NONPROFIT CORPORATIONS FOR PROFIT CORPORATIONS PAY TAXES ON PROFITS GENERATED BYT HE CORPORATIONS ENTERPRISES AND PAY DIVIDENS TO ________ON AFTER - TAX PROFITS. - Answer️️ -SHAREHOLDERS PARTICIPATING PROVIDERS CONTRACT TO PARTICIPATE IN A BCBS PLANS PREFERRED PROVIDER NETWORK(PPN) , WHICH IS A PROGRAM THAT REQUIRES PROVIDERS TO ADHERE TO __________CARE PROVISIONS - Answer️️ -MANAGED BCBS FEE FOR SERVICE ____ COVERAGE INCLUDES MIMINMUM BENEFITS SUCH AAS IMPATIENT HOSPITALIZATIONS AND DIAGNOSTIC LABORATORY SERVICES. - Answer️️ -BASIC BCBS FEE FOR SERVICE ________COVERAGE INCLUDES ADDITONAL BENEFITS , SUCH AS OFFICE VISITS, PHYSICAL AND OCCUPATIONAL THERAPHY, AND MENTAL HEALTH ENCOUNTERS. - Answer️️ -MAJOR MEDICAL ©SOPHIABENNETT EXAM SOLUTIONS_2024/2025 Monday, September 2, 2024 12:59 PM Page | 3 SOME BCBS CONTRACTS ALSO INCLUDE ONE OR MORE RIDERS, WHICH ARE SPECIAL CLAUSES THAT STIPULATE ADDITIONAL COVERAGE_______THE STANDARD CONTRACT. - Answer️️ -OVER AND ABOVE THE BCBS SPECIAL ACCIDENTAL INJURY RIDER COVERS NON SURGICAL CARE SOUGHT AND RENDERED WITHIN 24 HOURSTO 72 HOURS OF THE ACCIDENTIAL INJURY, DEPENDING ON PLAN BENEFITS. SURGICAL CAE IS SUBJECT TO ANY ESTABLISHED CONTRACT_____PLAN DEDCUTIBLES, AND CO- PAYMENTS. - Answer️️ -BASIC THE MEDICAL EMERGENCY CARE RIDER COVERS_____ TREATMENT SOUGHT, AND RECEIVED FOR SUDDEN , SERVERE, AND UNEXPECTED CONDITIONS THAT IF NOT TREATED WOULD PLACE THE PATIE