Health Care Communications Exam guide
with Complete Solutions/ Correct-Verified
Answers
open panel - ANSWER A managed care plan that contracts-directly or indirectly, with
private physicians to deliver care in their offices
closed panel - ANSWER A managed care plan in which covered insureds must select a primary
care physician, who has control over referrals to other physicians in or out of the group
point of service(POS) plan - ANSWER private insurance
-lower medical costs in exchange for more limited choice.
-combination of HMO and PPO
government accounting office(GAO) - ANSWER responsible for examining the use of public
funds to help the Congress make effective oversight, policy, and funding decisions
Center for Medicare and Medicaid Services(CMS) - ANSWER the federal body
*****responsible for administering Medicare***** and Medicaid programs
-also runs the Children's Health Insurance Program (CHIP)
medicare a - ANSWER federal insurance
-***covers case based Inpatient care
-hospital care
-****DOES pay for services provided by SPTAs
-(age 65) automatic enrollment social security benefits
, benefit period - ANSWER the time from the patient's admission into hospital until 60 days
after the discharge
-covered by 1 deductible and co-insurance fee
medicare b - ANSWER federal insurance
-***covers fee schedule outpatient care
-***DOES NOT pay for services provided by SPTAs
-optional enrollment
medicare c - ANSWER federal insurance
-***covers inpatient and outpatient care
-optional enrollment
medicare d - ANSWER federal insurance
-***prescription drug coverage
-coverage gap
-optional enrollment
medicaid - ANSWER federal and state insurance
-**covers low income families and children
-indigent care and children
coverage gap - ANSWER a temporary limit on what the drug plan will cover for
drugs -medicaid d
assignment - ANSWER to accept the Medicare-approved amount as full payment for covered
services
with Complete Solutions/ Correct-Verified
Answers
open panel - ANSWER A managed care plan that contracts-directly or indirectly, with
private physicians to deliver care in their offices
closed panel - ANSWER A managed care plan in which covered insureds must select a primary
care physician, who has control over referrals to other physicians in or out of the group
point of service(POS) plan - ANSWER private insurance
-lower medical costs in exchange for more limited choice.
-combination of HMO and PPO
government accounting office(GAO) - ANSWER responsible for examining the use of public
funds to help the Congress make effective oversight, policy, and funding decisions
Center for Medicare and Medicaid Services(CMS) - ANSWER the federal body
*****responsible for administering Medicare***** and Medicaid programs
-also runs the Children's Health Insurance Program (CHIP)
medicare a - ANSWER federal insurance
-***covers case based Inpatient care
-hospital care
-****DOES pay for services provided by SPTAs
-(age 65) automatic enrollment social security benefits
, benefit period - ANSWER the time from the patient's admission into hospital until 60 days
after the discharge
-covered by 1 deductible and co-insurance fee
medicare b - ANSWER federal insurance
-***covers fee schedule outpatient care
-***DOES NOT pay for services provided by SPTAs
-optional enrollment
medicare c - ANSWER federal insurance
-***covers inpatient and outpatient care
-optional enrollment
medicare d - ANSWER federal insurance
-***prescription drug coverage
-coverage gap
-optional enrollment
medicaid - ANSWER federal and state insurance
-**covers low income families and children
-indigent care and children
coverage gap - ANSWER a temporary limit on what the drug plan will cover for
drugs -medicaid d
assignment - ANSWER to accept the Medicare-approved amount as full payment for covered
services
