1. Explain what is meant by respondeat superior
2. Explain medical malpractice insurance and why it is important to physicians and other healthcare professionals
3. Explain what is meant by medical necessity and give an example
4. Explain the importance of ethics in the professional workplace
5. List the levels of the Healthcare Common Procedure Coding System
6. What is meant by scope of practice?
7. List the four types of insurance that healthcare providers and facilities typically purchase to cover their employees
8. Why is preauthorization important?
9. Explain what is meant by a hold harmless clause
10. Describe what is meant by coding
11. What is meant by medical care?
12. Give the definition of health insurance
13. What is the definition of an electronic health record?
14. What is the importance of NCCI?
15. What is the Resource-Based Relative Value Scale (RBRVS) System?
16. What are usual and reasonable payments based on?
17. What medical practice functions does total practice management software automate?
18. Describe continuity of care
19. In 1947, the Taft-Hartley Act initiated the creation of third-party administrators (TPAs).
What is a third-party administrator?
20. What does major medical insurance cover, and what are some of the drawbacks of these policies?
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21. What is Title XVII coverage and who does it cover?
22. What is Title XIX coverage and who does it cover?
23. After the patient pays the copayment and the payer reimburses the provider according to its fee schedule, what happens to the remaining balance?
24. What is the purpose of a managed care plan?
25. What is a fee-for-service plan?
26. What is the role of the primary care provider (PCP)?
27. What is the role of utilization management (or utilization review)?
28. What is the difference between preadmission certification (PAC) and
preauthorization?
29. Explain case management
30. What is the reason for a second surgical opinion?
31. Why did Medicare prohibit gag clauses?
32. What is a medical foundation?
33. What is a point-of-service plan?
34. What is a health maintenance organization (HMO) plan?
35. What is a preferred provider organization (PPO)?
36. Explain the advantages of a triple option plan
37. Define concurrent review
38. List the five types of health maintenance organizations on your textbook
39. What is the purpose of the NCQA?
40. Explain the difference between assignment of benefits and accept assignment
41. Explain the difference between a participating provider (PAR) and a non-participating provider (non-PAR)
42. When a provider’s office contacts the payer to verify a patient’s insurance eligibility and benefit status, HIPAA privacy standards mandate that four areas of pertinent information be provided. Name them
43. Explain primary insurance versus secondary insurance
44. What is the birthday rule?
45. What is the gender rule?
46. Define encounter form, and distinguish between a superbill and a chargemaster
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47. What is the patient ledger?
48. What is a clearinghouse?
49. What does the claims adjudication process verify?
50. Explain allowed charges
