Deck 23: Health Insurance Basics

Question 1

Which part of Medicare covers prescription drug services?

A) A
B) B
C) C
D) D

Answer 1

D

Question 2

Veterans of the U.S. armed forces may be covered by

A) CHAMPVA.
B) TRICARE.
C) workers' compensation.
D) Blue Cross/Blue Shield.

Answer 2

CHAMPVA.

Question 3

The medical assistant should always verify which of the following prior to the patient's appointment?

A) Eligibility
B) Benefits and exclusions
C) Effective date of insurance
D) All of the above

Answer 3

All of the above

Question 4

Which of the following individuals would not normally be eligible for Medicare?

A) A 66-year-old retired woman
B) A blind teenager
C) A 23-year-old recipient of AFDC
D) A person on dialysis

Question 5

A type of insurance that protects workers from loss of wages after an industrial accident that happened on the job is called

A) an individual policy.
B) workers' compensation.
C) unemployment insurance.
D) disability insurance.

Question 6

A payment method in which providers are paid for each individual enrolled in a plan, regardless of whether the person sees the provider that month, is called a ______ plan.

A) capitation
B) self-insured
C) managed care
D) fee-for-service

Question 7

Employer group policies usually provide greater benefits at lower premiums because of the large pool of people from whom premiums are collected. However, these employee-sponsored group health insurance plans offer limited benefits, and healthcare access is limited to healthcare providers that are contracted with them.

A) Both statements are true.
B) Both statements are false.
C) The first statement is true; the second is false.
D) The first statement is false; the second is true.

Question 8

The federal and state funded health insurance program for the medically indigent is called

A) Medicare.
B) Medicaid.
C) Medigap.
D) MediCal.

Question 9

Which of the following expenses would be paid by Medicare Part B?

A) Inpatient hospital charges
B) Hospice services
C) Physician's office visits
D) Home healthcare charges

Question 10

A policy that covers a number of people under a single contract issued to the employer

A) group policy.
B) individual policy.
C) a government plan.
D) a self-insured plan.

Question 11

Which type of HMO model consists of a provider group that contracts with one or more HMOs, but can also patients outside of the HMO?

A) Staff model
B) Independent practice association
C) Group model
D) None of the above

Question 12

Health insurance designed for military dependents and retired military personnel is called

A) CHAMPVA.
B) TRICARE.
C) Medicare.
D) Medicaid.

Question 13

Medigap polices cover which of the following?

A) Medicare deductible
B) Medicare co-insurance
C) Services not covered under Medicare
D) All of the above

Question 14

The amount of money paid to keep an insurance policy in force is the

A) premium.
B) deductible.
C) co-pay.
D) co-insurance.

Question 15

The physician who enters into a contract with an insurance company and agrees to certain rules and regulations is called a ______ provider.

A) participating
B) paying
C) physician
D) None of the above

Question 16

Which of the following plans require healthcare providers to become participating providers?

A) All government-sponsored health plans
B) Most privately sponsored health plans
C) Indemnity health insurance plans
D) Both A and B
E) All of the above

Question 17

A review of individual cases by a committee to make sure that services are medically necessary is called a(n)

A) credentialing committee review.
B) peer review committee evaluation.
C) utilization review.
D) audit committee review.

Question 18

Which of the following MCOs typically has/have the lowest monthly premiums with lower patient financial responsibility?

A) IPA
B) PPOs
C) HMOs
D) None of the above

Question 19

The amount of money the policyholder pays per claim before the insurance company will pay on the claim is known as the

A) exclusion.
B) premium.
C) deductible.
D) remittance.

Question 20

Organizations that fund their own insurance programs offer their employees

A) group coverage.
B) individual coverage.
C) government plans.
D) self-funded plans.

Question 21

A document sent by the insurance company to the provider and the patient explaining the allowed charge, the amount reimbursed for services, and the patient's financial responsibilities is

A) explanation of benefits.
B) fee schedule.
C) claim.
D) policy.

Question 22

Which part of Medicare covers inpatient hospital charges?

A) Part A
B) Part B
C) Part C
D) Part D

Question 23

An order from a primary care provider for the patient to see a specialist is a(n)

A) preauthorization.
B) policy.
C) referral.
D) health insurance exchange.

Question 24

A set dollar amount that the policyholder must pay for each office visit is

A) premium.
B) deductible.
C) co-pay.
D) co-insurance.

Question 25

A designated person who receives funds from an insurance policy is

A) beneficiary.
B) claimant.
C) gatekeeper.
D) indigent.

Question 26

A process required by some insurance carriers in which the provider obtains permission to perform certain procedures or services is

A) preauthorization.
B) referral.
C) utilization management.
D) None of the above

Question 27

An approved list of physicians, hospitals, and other providers is a(n)

A) explanation of benefits.
B) health insurance exchange.
C) third-party administrator.
D) provider network.

Question 28

A certain percentage of the allowed amount that the policyholder is responsible for is

A) premium.
B) deductible.
C) co-pay.
D) co-insurance.

Question 29

In some managed care plans referrals to a specialist must be approved by the

A) beneficiary.
B) gatekeeper.
C) third-party administrator.
D) policyholder.

Question 30

Services that are needed to improve the patient's current health are considered

A) elective.
B) preventive.
C) medically necessary.
D) provider network.

Question 31

Which of the following managed care plans require preauthorization for medical services such as surgery?

A) HMOs
B) PPOs
C) EPOs
D) All of the above

Question 32

Service provided to stop certain conditions from occurring or to lead to an early diagnosis are considered

A) elective.
B) preventive.
C) medically necessary.
D) provider network.

Question 33

Someone who is poor, needy, or impoverished is considered

A) uninsurable.
B) a cash only patient.
C) indigent.
D) None of the above

Question 34

Under which of the following Medicare plans for primary care and specialists' services is the patient required to pay a monthly premium?

A) Part A
B) Part B
C) Part C
D) Part D

Question 35

The Affordable Care Act includes which of the following categories of essential health benefits?

A) Emergency services
B) Laboratory services
C) Prescription drugs
D) All of the above

Question 36

A written agreement between two parties, where one party agrees to pay another party if certain specified circumstances occur is a

A) policy.
B) preauthorization.
C) referral.
D) fee schedule.

Question 37

An organization that processes claims and provides administrative services for another organization is

A) utilization management.
B) resource-based relative value system.
C) third-party administrator.
D) provider network.

Question 38

A list of the fixed fees for services is a

A) explanation of benefits.
B) fee schedule.
C) claim.
D) policy.

Question 39

A formal request for payment from an insurance company for services provided is

A) explanation of benefits.
B) fee schedule.
C) claim.
D) policy.

Question 40

Which of the following are not reviewed by a utilization review committee?

A) Physician referrals
B) Emergency department visits and urgent care
C) Urgent care visits
D) Fees for services provided

Question 41

Health insurance typically covers services and procedures considered medically necessary. Most insurance policies also cover "elective" procedures, such as certain cosmetic surgeries, that are not considered medically necessary.

Question 42

Individual health insurance plans cover only one person.

Question 43

The health insurance mode that offers the least flexibility for patients is

A) fee-for-service.
B) health maintenance organizations.
C) preferred provider organizations.
D) exclusive provider organizations.

Question 44

The allowed amount for Medicare charges is determined using

A) fee schedule.
B) resource-based relative value scale.
C) utilization management.
D) provider network.

Question 45

RBRVS consists of three parts, including which of the following?

A) Provider work
B) Charge-based professional liability expenses
C) Charge-based overhead
D) All of the above

Question 46

A provider can choose whether to accept Medicaid patients.

Question 47

TRICARE is a form of government insurance for veterans of the U.S. armed forces.

Question 48

There are no government managed care plans.

Question 49

Which of the following services must be covered by Medicaid in each state?

A) Family planning services
B) Transportation of medical care
C) Nurse Midwife services
D) All of the above

Question 50

The health insurance model that offers the most flexibility for patients is

A) traditional health insurance.
B) managed care organizations.
C) Medicare.
D) Medicaid.