HCA 460 Midterm UPDATED ACTUAL
Questions and CORRECT Answers
Contract - CORRECT ANSWER- ✔✔An agreement between two or more parties to perform
specific services or duties
First party - CORRECT ANSWER- ✔✔the person designated in the contract to receive a
contracted service
Second party - CORRECT ANSWER- ✔✔the person or organization providing the service
Third party - CORRECT ANSWER- ✔✔the one who has no binding interest in a specific
contract
Guardian - CORRECT 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 - CORRECT ANSWER- ✔✔the unauthorized release of
confidential patient information to a third party.
Reason behind breach of confidentiality - CORRECT 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 providers, they must be
assured that they can control the release of the information given to the hc providers.
Authorized release of information - CORRECT ANSWER- ✔✔a written permission to
release necessary medical information to an insurance company or other third party
Coordination of benefits clause - CORRECT 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 - CORRECT ANSWER- ✔✔An intentional deception or misrepresentation that an
individual makes, knowing it to be false which could result in some unauthorized benefit.
Abuse - CORRECT ANSWER- ✔✔Incidents or practices while not considered fraudulent,
are not consistent with accepted sound medical, business or fiscal practices.
Fraudulent Claim's - CORRECT ANSWER- ✔✔Billing for services not rendered.
Different diagnosis (DRG)
Additional treatment
An increase in the charges.
Change the date of treatment.
Larger medical deduction on patients' income tax than they are entitled.
Circumventing a coordination of benefits clause.
Insurance - CORRECT 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 - CORRECT ANSWER- ✔✔reimbursement for lost income resulting
from a temporary or permanent illness or injury
Liability insurance - CORRECT 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 - CORRECT ANSWER- ✔✔an individual or corporation that makes a
payment on an obligation/debt, but is not a party to the contract that created the
obligation/debt.
Third party payor's are: - CORRECT ANSWER- ✔✔Commerical medical insurance policies
covering the policyholders and dependent members of their families.
Questions and CORRECT Answers
Contract - CORRECT ANSWER- ✔✔An agreement between two or more parties to perform
specific services or duties
First party - CORRECT ANSWER- ✔✔the person designated in the contract to receive a
contracted service
Second party - CORRECT ANSWER- ✔✔the person or organization providing the service
Third party - CORRECT ANSWER- ✔✔the one who has no binding interest in a specific
contract
Guardian - CORRECT 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 - CORRECT ANSWER- ✔✔the unauthorized release of
confidential patient information to a third party.
Reason behind breach of confidentiality - CORRECT 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 providers, they must be
assured that they can control the release of the information given to the hc providers.
Authorized release of information - CORRECT ANSWER- ✔✔a written permission to
release necessary medical information to an insurance company or other third party
Coordination of benefits clause - CORRECT 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 - CORRECT ANSWER- ✔✔An intentional deception or misrepresentation that an
individual makes, knowing it to be false which could result in some unauthorized benefit.
Abuse - CORRECT ANSWER- ✔✔Incidents or practices while not considered fraudulent,
are not consistent with accepted sound medical, business or fiscal practices.
Fraudulent Claim's - CORRECT ANSWER- ✔✔Billing for services not rendered.
Different diagnosis (DRG)
Additional treatment
An increase in the charges.
Change the date of treatment.
Larger medical deduction on patients' income tax than they are entitled.
Circumventing a coordination of benefits clause.
Insurance - CORRECT 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 - CORRECT ANSWER- ✔✔reimbursement for lost income resulting
from a temporary or permanent illness or injury
Liability insurance - CORRECT 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 - CORRECT ANSWER- ✔✔an individual or corporation that makes a
payment on an obligation/debt, but is not a party to the contract that created the
obligation/debt.
Third party payor's are: - CORRECT ANSWER- ✔✔Commerical medical insurance policies
covering the policyholders and dependent members of their families.
