AHM 250- Introduction To Health
Management (21-24) 250 Questions
And Answers Latest Update
Ethics - Answers are the principles and values that guide the actions
of an individual or a population when faced with questions of right and
wrong.
Truth-telling and promise-keeping. - Answers Health plans and their
providers must present information honestly and honor commitments.
TRICARE - Answers is the U.S. Department of Defense healthcare
plan, serving members of the military and other uniformed services of the
U.S. government, retirees, and their spouses and dependents. TRICARE
uses a worldwide system of military hospitals and clinics as its main
healthcare delivery system, but this is augmented by a network of civilian
providers and facilities. TRICARE provides coverage to nearly 10 million
people.
Workers' compensation - Answers is a state-mandated insurance
program that provides benefits to cover healthcare costs and lost earnings
for employees who suffer a work-related injury or illness.
The Federal Employees Health Benefits (FEHB) Program - Answers
provides health coverage for full-time employees of the United States
, Q&A
government, qualified retirees, and their spouses, dependents, and
survivors.
PACE (Program of All-Inclusive Care for the Elderly). - Answers It
provides community-based long-term care at a capitated rate to frail
persons age 55 and older who would otherwise need nursing home care.
While some services are available in an individual's home, most are
provided at an adult day center. However, although PACE is a widely
praised model, total enrollment is extremely small (less than 16,000
nationwide, half of this in only five states.
premium assistance. - Answers . Persons who qualify for Medicaid
or CHIP but who also have access to employer-sponsored health insurance
enroll in the employer plan, and the state pays the premium. Often the
premium for family members not eligible for Medicaid or CHIP is also paid.
The state pays cost-sharing (deductibles, coinsurance, and copayments)
for Medicaid-eligibles; CHIP-eligibles may have to pay some cost-sharing
themselves, depending on their income. Finally, the state provides wrap
coverage
Quality Standards - Answers Another change made by the BBA was
the establishment of quality standards and recipient protections for
Medicaid health plans. These require plans to:
• demonstrate adequate capacity and services,
• meet certain quality assurance standards,
• assure coverage of emergency services,
• have a grievance process in place, and
• ensure that mechanisms are in place to assess the quality and
appropriateness of care to enrollees with special healthcare needs.
, Q&A
claim - Answers is a request to an insurer or health plan for payment
of benefits.
it usually takes the form of an itemized statement of healthcare services
delivered by a healthcare provider to a covered person, along with the cost
of those services.
Claims administration or claims processing - Answers the receiving,
reviewing, adjudicating, and paying of claims.
claimant - Answers person or entity submitting a claim
adjudicate - Answers a claim is to make determinations and
decisions about it.)
In traditional indemnity health insurance claims is paid? - Answers
the provider sends a bill to the insurer for the services delivered. The
insurer processes the claim to determine if payment is in fact due and if so
pays the provider or insured.
encounter - Answers is a visit by a plan member to a provider of
healthcare or related service
encounter report - Answers includes the services provided, the date
of service, the diagnosis, and other information.(used when physicians are
under salary or capitation)
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