HCA 460 Midterm Exam Study Guide Solutions

HCA 460 Midterm Exam Study Guide Solutions Contract - ANSWER-An agreement between two or more parties to perform specific services or duties First party - ANSWER-the person designated in the contract to receive a contracted service Second party - ANSWER-the person or organization providing the service Third party - ANSWER-the one who has no binding interest in a specific contract Guardian - ANSWER-the person who is legally designated to be in charge of the patient's affairs. The patient is a minor or an incompetent adult. Breach of Confidentiality - ANSWER-the unauthorized release of confidential patient information to a third party. Reason behind breach of confidentiality - ANSWER-For providers to properly treat patients, the patients must be willing to be examined and be touched by the medical professionals, thus revealing to the providers not only why they sought medical advice, but also how the problem has affected them and at times revealing their inner thoughts and feelings. If the patients are to open up to the health care Copyright © KAYLIN 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH NOVEMBER, 2024 Copyright © Stuvia International BV Page 2/6 providers, they must be assured that they can control the release of the information given to the hc providers. Authorized release of information - ANSWER-a written permission to release necessary medical information to an insurance company or other third party Coordination of benefits clause - ANSWER-Restrict payment by insurance companies to more than 100 percent of the covered benefits. The second insurer requires a statement of benefits paid by the primary insurer before paying its share of the procedures performed. Fraud - ANSWER-An intentional deception or misrepresentation that an individual makes, knowing it to be false which could result in some unauthorized benefit. Abuse - ANSWER-Incidents or practices while not considered fraudulent, are not consistent with accepted sound medical, business or fiscal practices. Fraudulent Claim's - ANSWER-Billing for services not rendered. Different diagnosis (DRG) Additional treatment An increase in the charges. Change the date of treatment. Copyright © KAYLIN 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH NOVEMBER, 2024 Copyright © Stuvia International BV Page 3/6 Larger medical deduction on patients' income tax than they are entitled. Circumventing a coordination of benefits clause. Insurance - ANSWER-Protection against risk, loss or ruin by a contract in which an insurer or underwriter guarantees to pay a sum of money to the insured in the event of some contingency such as death, accident or illness, in return for the payment of a premium. Disability Insurance - ANSWER-reimbursement for lost income resulting from a temporary or permanent illness or injury Liability insurance - ANSWER-a policy that covers losses to a 3rd party caused by the insured, by an object owned by the insured, or on the premises owned by the insured. Health benefits are secondary to. Third party payor - ANSWER-an individual or corporation that makes a