Health Insurance Today: Chapter 11

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1

Social Security disability benefits do not cover the first ________ of the disability.

6 months

2

The examining body that determines whether an applicant qualifies for SSDI is the:

Social Security administration

3

After eliminating all items not considered income and applying all appropriate exclusions to the items that are income, what’s left is referred to as:

Countable Income

4

The income limit for the SSI program is based on:

Federal Benefit Rate

5

The type of insurance that replaces a portion of earned income when an individual is unable to perform the requirements of his or her job because of non-job related injury or illness is called:

Disability Insurance

6

A patients inability to perform normal job duties at the previous level of expertise as a result of being absent from work is called:

Job deconditioning

7

The time limit for filing a workers compensation claim is established by the:

Individual state statutes

8

The federal program that establishes workers compensation for railroad workers engaged in interstate commerce is known by the acronym:

FELA

9

In workers compensation insurance, the premiums are paid by:

The employer

10

The _____ initiates an SSI or SSDI claim by going to the nearest social security office in person or by telephoning and arranging for a telephone interview to file the claim.

Patient

11

All employers must purchase workers compensation policies from the state in which their business operates.

True

12

If an employee is injured on the job, the employer can be penalized if the cause of injury or illness was conspicuous negligence on the part of the employer.

True

13

If a workers compensation claim is denied, the worker may file a claim with his or her health insurance carrier only after all workers compensation appeals have been exhausted

True

14

Workers compensation claims must be submitted on the universal CMS 1500 claim form.

False

15

Workers compensation patients are not required to sign a release of information for a claim to be filed.

True

16

The SSI program provides monthly cash payments to low income aged, blind, and disabled individuals.

True

17

The SSDI and SSI programs share various concepts and terms. However there are many important differences in the rules affecting eligibility and benefit payments.

True

18

The premium costs of managed care option can not be less than a FFS option that states offer for WC insurance.

False

19

The ADA considers disability present if an individual meets the following three standards: physical or mental impairment, en existing record of impairments and the individual is regarded as having an impairment.

True

20

The social security insurance claim form can be completed online

False

21

The health insurance professional typically does not get involved in the SSDI or SSI claim process.

False

22

The HIPPA privacy rule does not permit covered entities to disclose PHI to WC insurance without patients signing a release of information

False

23

WC insurance is a no fault insurance

True

24

In the United States, any employee who is injured on the job or develops and employment related illness that prevents the individual from working is likely to be eligible to collect workers' compensation benefits

True

25

Short term disability replaces income for 5 years or more, or until the disabled patient turns 65 years of age.

False

26

The CDC Control and Prevention support 18 state-based disability and health programs. The programs' goals focus is promoting safe workplace procedures.

False

27

In the 1800's Workers' Compensation got its start in:

Germany

28

The maximum amount of benefits that can be received in a specific time period is called:

A benefit cap

29

After the initial attending physician report has been filed, periodic updates must be provided to the employer/insurer, called:

Progress and supplemental reports.

30

The method of determining whether or not an individual is eligible for SSI benefits is through a(n):

Financial Means Test

31

The following multiple copies of Workers' Compensation reports are essential for proper distribution:

Original form to the insurance company

One copy to the appropriate state agency

One copy to the patients' employer

One copy to be retained in the healthcare provider's file

32

Select the work related incidents in which injury occurs that would be exclusions to the employee drawing Workers' Compensation benefits:

  1. Horseplay
  2. Drunken stumbling
  3. Illegal drug are involved
  4. Self inflicted injuries
  5. Violating company policy
  6. Committing a crime
  7. Injuries while off work