BCBS Exam Questions and Answers All Correct

BCBS Exam Questions and Answers All Correct Origin of Blue cross - Answer-1929 BCBS originally covered only: - Answer-Hospital Bills Resolution passed by the House of Delegates at an American Medical Assosiation: What Year? - Answer-1938 Resolution supported physicians to do what? - Answer-cooperate with prepaid healthcare plans First known prepaid health plan was formed where? - Answer-Alto, California In what year was the first known prepaid health plan? - Answer-1939 Blue Shield originally covered fees for? - Answer-Physician services 1977 - Answer-Separate Blue Cross and Blues Shield combined personnel, with a single president responsible to both boards of directors 1986 - Answer-Separate Boards of Directors merged into a Single Corporation Blue Cross Blue Shield Association BCBSA - Answer-Blue Cross Blue Shield Association Nonprofit Corporations - Answer-Charitable, educational, civic, or humanitarian organizations whose profits are returned to the program of the corporation rather than distributed to shareholders and officers of the corporation For-profit Corporations - Answer-Pay taxes on profits generated by corporations' for- profit enterprises and pay dividends to shareholders on after tax-profits BCBS agrees to perform the following services - Answer-Make prompt, direct payment of claims Maintain regional professional representatives to assist participating providers with claim problems Provide educational seminar, workshops, billing manuals, and newsletters to keep participating providers up-to-date on BCBS insurance procedures Exchange for ta relief for BCBS nonprofit status - Answer-FORBIDDEN, by state law from canceling coverage for an individual because he or she is in poor health or BCBS payments to provders have far exceeded the average Fee-for-service Insurance (Indemnity) - Answer-Traditional health care insurance that covers a portion of services, such as hospital inpatient hospitalizations or physician office visits, with the patient paying the remaining costs Managed care plans - Answer-Coordinated home health and hospice care Exclusive provider organization Health maintenance organization Outpatient pretreatment authorization plan Point-of-services plan Preferred provider opinion Second surgical opinion Federal Employee Program - Answer-FEP Medicare supplemental plans - Answer-These enhance the Medicare program by paying for Medicare duductables and copayments Healthcare Anywhere - Answer-The BlueCard Program Also known as Medigap Plans - Answer-Medicare Supplemental plans FEP is an employer-sponsored health benefits program established by an Act of Congress- what year? - Answer-1959 Local Plans - Answer-FEP is underwritten and administered by participating insurance plans called? Four enrollment options - Answer-101-Individual, High Option Plan 102-Family, High Option Plan 104-Individual, Standard (low) Option Plan 105-Family, Standard (low) Option Plan BlueWorldwide Expat - Answer-Provides global medical coverage for active employees and their dependents who spend more than six months outside of the United States Second Surgical Opinion - Answer-Necessary when a patient is considering elective, non-emergency surgical care PPO - Answer-Preferred Provider Organization-Subscriber (member) is responsible for remaining within the network or PPO providers and must request referrals to PPO specialists whenever possible POS - Answer-Point of Service-allows subscribers to choose, at the time medical services are needed, whether they will go to a provider within the plans' network or outside the network HMO - Answer-Health Maintenance Organization-Plan that assmes or shares the financial and healthcare delivery risks associated with providing comprehensive medical services to subscribers in return for a fixed, prepaid fee EPO - Answer-Exclusive Provider Organization- provides healthcare services through a network of doctors, hospitals, and other healthcare providers