Deck 14: The Muscular System

Question 1

Under workers' compensation, a patient who has an industrial injury is billed:

A) for 20 percent of the cost of treatment
B) for 80 percent of the cost of treatment
C) for the entire cost of treatment
D) if treatment was given without authorization

Answer 1

if treatment was given without authorization

Question 2

Physicians who treat patients under workers' compensation plans are usually required to register with the state Workers' Compensation Board:

A) anytime they need to file a claim
B) only once, unless they move or change the name of the medical practice
C) on an annual basis
D) every 5 years

Answer 2

on an annual basis

Question 3

In a(n) _____ plan, patients are able to see specialists without having to obtain referrals from another physician.

A) preferred provider organization (PPO)
B) health maintenance organization (HMO)
C) independent practice association (IPA)
D) indemnity-type insurance

Answer 3

indemnity-type insurance

Question 4

When a patient arrives at the medical office, you should copy _____ of the insurance card(s).

A) only the front
B) only the back
C) both sides
D) neither side

Question 5

The term ____ refers to the discovery of the maximum amount of money that a carrier will pay for primary surgery, consultation services, an so on.

A) precertification
B) pretreatment
C) preauthorization
D) predetermination

Question 6

Ideally, a person in each medical office is designated as the ____ and is expected to maintain currency with insurers and insurance regulations.

A) medical coder
B) claims filer
C) update technician
D) seminar specialist

Question 7

Blue Cross was originally set up to pay for:

A) physicians' services
B) hospital expenses
C) prescription medications
D) preventive health care

Question 8

Part ___ of Medicare is for payment of medical expenses such as office visits and x-ray and laboratory services.

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

Question 9

When a provider does not accept assignment from Medicare, the most that can be charged to the patient is ___ of the Medicare-approved amount.

A) 85%
B) 100%
C) 115%
D) 150%

Question 10

A provider may not charge a patient for:

A) the part of the deductible that has not been met
B) an amount reimbursed after accepting assignment
C) any coinsurance that is due
D) a service not covered by the patient's insurance

Question 11

Under the birthday rule, if the parents divorce and retain their plans, the parent with _____ is primary.

A) the greater income
B) the plan in effect the longest
C) custody
D) the parent with the plan that provides the best coverage

Question 12

Medicaid cards are issued to recipients on a(n) ____ basis.

A) monthly
B) annual
C) biannual
D) as-needed

Question 13

Once a patient is ready to leave the hospital, ____ is used to ensure that the patient is being discharged to the most appropriate setting.

A) discharge planning
B) capitation
C) utilization review
D) diagnostic planning

Question 14

Because a primary care physician (PCP) in an HMO makes referrals and approves additional care if needed, he or she is known as the:

A) gatekeeper
B) patient advocate
C) specialist
D) care manager

Question 15

Medicare pays ____ of the approved medical bill amount once the deductible is satisfied.

A) 20
B) 60
C) 70
D) 80

Question 16

When patients without health insurance are seen in the medical practice, they are classified as ____ patients.

A) pro bono
B) self-pay
C) reimbursement
D) TRICARE

Question 17

Which type of HMO is composed of providers who practice in their own individual offices and retain their own staff and operations?

A) staff model
B) group model
C) PPO
D) independent practice association

Question 18

Part ___ of Medicare was created to provide coverage for both generic and brand name drugs.

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

Question 19

The only practitioners that can currently bill Medicare with the hard copy CMS-1500s are businesses with:

A) less than 10 full-time employees, including physicians
B) more than 20 full-time employees, including physicians
C) less than 10 full-time employees, excluding physicians
D) more than 20 full-time employees, excluding physicians

Question 20

Health insurance offered by private companies to persons eligible for Medicare benefits and specifically designed to supplement such benefits is called:

A) Medigap
B) Medicaid
C) TRICARE
D) CHAMPVA

Question 21

Match each health insurance term with its definition.
Condition that existed before the insured's policy was issued

A)managed care
B)Medicaid
C)precertification
D)preexisting condition
E)service area
F)subscriber
G)individual insurance
H)indemnity plan
I)utilization management (review)
J)workers' compensation

Question 22

Match each health insurance term with its definition.
Commercial plan in which the insurance company or group reimburses physicians or beneficiaries for services

A)managed care
B)Medicaid
C)precertification
D)preexisting condition
E)service area
F)subscriber
G)individual insurance
H)indemnity plan
I)utilization management (review)
J)workers' compensation

Question 23

Match each health insurance term with its definition.
Insurance purchased by an individual or family who does not have access to group health insurance

A)managed care
B)Medicaid
C)precertification
D)preexisting condition
E)service area
F)subscriber
G)individual insurance
H)indemnity plan
I)utilization management (review)
J)workers' compensation

Question 24

Match each health insurance term with its definition.
Health care delivery system that combines the delivery of health care and payment of the services

A)managed care
B)Medicaid
C)precertification
D)preexisting condition
E)service area
F)subscriber
G)individual insurance
H)indemnity plan
I)utilization management (review)
J)workers' compensation

Question 25

Match each health insurance term with its definition.
Government program that provides insurance coverage for those who are injured on the job or who have developed work-related disorders, disabilities, or illnesses

A)managed care
B)Medicaid
C)precertification
D)preexisting condition
E)service area
F)subscriber
G)individual insurance
H)indemnity plan
I)utilization management (review)
J)workers' compensation

Question 26

Match each health insurance term with its definition.
Specified amount that the insured must pay toward the charge for professional services rendered at the time of service

A)assignment of benefits
B)TRICARE
C)CHAMPVA
D)coordination of benefits (COB)
E)copayment
F)deductible
G)effective date
H)capitation
I)group insurance
J)health maintenance organization (HMO)

Question 27

Match each health insurance term with its definition.
Person who is insured; an insurance policy holder

A)managed care
B)Medicaid
C)precertification
D)preexisting condition
E)service area
F)subscriber
G)individual insurance
H)indemnity plan
I)utilization management (review)
J)workers' compensation

Question 28

Match each health insurance term with its definition.
Method of controlling health care costs by reviewing services to be provided to members of a plan to determine the appropriateness and medical necessity of the care prior to the delivery of the care

A)managed care
B)Medicaid
C)precertification
D)preexisting condition
E)service area
F)subscriber
G)individual insurance
H)indemnity plan
I)utilization management (review)
J)workers' compensation

Question 29

Match each health insurance term with its definition.
Established for the spouses and dependent children of veterans who have total, permanent, service-connected disabilities

A)assignment of benefits
B)TRICARE
C)CHAMPVA
D)coordination of benefits (COB)
E)copayment
F)deductible
G)effective date
H)capitation
I)group insurance
J)health maintenance organization (HMO)

Question 30

Match each health insurance term with its definition.
Insurance offered to all employees by the employer

A)assignment of benefits
B)TRICARE
C)CHAMPVA
D)coordination of benefits (COB)
E)copayment
F)deductible
G)effective date
H)capitation
I)group insurance
J)health maintenance organization (HMO)

Question 31

Match each health insurance term with its definition.
Procedures used by insurers to avoid duplication of payment on claims when a patient has more than one policy

A)assignment of benefits
B)TRICARE
C)CHAMPVA
D)coordination of benefits (COB)
E)copayment
F)deductible
G)effective date
H)capitation
I)group insurance
J)health maintenance organization (HMO)

Question 32

Match each health insurance term with its definition.
Established to aid dependents of active service personnel, retired service personnel and their dependents, and dependents of service personnel who died on active duty, with a supplement for medical care in military or Public Health Service facilities

A)assignment of benefits
B)TRICARE
C)CHAMPVA
D)coordination of benefits (COB)
E)copayment
F)deductible
G)effective date
H)capitation
I)group insurance
J)health maintenance organization (HMO)

Question 33

Match each health insurance term with its definition.
Date when an insurance policy goes into effect

A)assignment of benefits
B)TRICARE
C)CHAMPVA
D)coordination of benefits (COB)
E)copayment
F)deductible
G)effective date
H)capitation
I)group insurance
J)health maintenance organization (HMO)

Question 34

Match each health insurance term with its definition.
When a health care provider is paid a fixed amount per member per month for each patient who is a member of a particular insurance organization, whether or not services were provided

A)assignment of benefits
B)TRICARE
C)CHAMPVA
D)coordination of benefits (COB)
E)copayment
F)deductible
G)effective date
H)capitation
I)group insurance
J)health maintenance organization (HMO)

Question 35

Match each health insurance term with its definition.
Group insurance that entitles members to services provided by participating hospitals, clinics, and physicians

A)assignment of benefits
B)TRICARE
C)CHAMPVA
D)coordination of benefits (COB)
E)copayment
F)deductible
G)effective date
H)capitation
I)group insurance
J)health maintenance organization (HMO)

Question 36

Match each health insurance term with its definition.
Geographic area served by an insurance carrier

A)managed care
B)Medicaid
C)precertification
D)preexisting condition
E)service area
F)subscriber
G)individual insurance
H)indemnity plan
I)utilization management (review)
J)workers' compensation

Question 37

Match each health insurance term with its definition.
Authorization, by signature, of a patient for payment to be paid directly to the physician for services

A)assignment of benefits
B)TRICARE
C)CHAMPVA
D)coordination of benefits (COB)
E)copayment
F)deductible
G)effective date
H)capitation
I)group insurance
J)health maintenance organization (HMO)

Question 38

Match each health insurance term with its definition.
Approval obtained before the patient is admitted to the hospital or receives specified outpatient or in-office procedures

A)managed care
B)Medicaid
C)precertification
D)preexisting condition
E)service area
F)subscriber
G)individual insurance
H)indemnity plan
I)utilization management (review)
J)workers' compensation

Question 39

Match each health insurance term with its definition.
Joint funding program by federal and state governments (excluding Arizona) for the medical care of low-income patients on public assistance

A)managed care
B)Medicaid
C)precertification
D)preexisting condition
E)service area
F)subscriber
G)individual insurance
H)indemnity plan
I)utilization management (review)
J)workers' compensation

Question 40

Match each health insurance term with its definition.
Predetermined amount that the insured must pay each year before the insurance company will pay for an accident or illness

A)assignment of benefits
B)TRICARE
C)CHAMPVA
D)coordination of benefits (COB)
E)copayment
F)deductible
G)effective date
H)capitation
I)group insurance
J)health maintenance organization (HMO)

Question 41

Match each health insurance term with its definition.
Term for an insurance company that reimburses for health care services

A)Advance Beneficiary Notice (ABN)
B)carrier
C)coordination of benefits (COB)
D)fee disclosure
E)fee schedule
F)loss-of-income benefits
G)participating provider
H)patient status
I)Relative Value Units
J)third-party payer

Question 42

Match each health insurance term with its definition.
Required by Medicare when a service is provided to a beneficiary who is either not covered or the provider is unsure of coverage

A)Advance Beneficiary Notice (ABN)
B)carrier
C)coordination of benefits (COB)
D)fee disclosure
E)fee schedule
F)loss-of-income benefits
G)participating provider
H)patient status
I)Relative Value Units
J)third-party payer

Question 43

Match each health insurance term with its definition.
Numeric values assigned to payment components of the Resource-Based Relative Value Scale (RBRVS)

A)Advance Beneficiary Notice (ABN)
B)carrier
C)coordination of benefits (COB)
D)fee disclosure
E)fee schedule
F)loss-of-income benefits
G)participating provider
H)patient status
I)Relative Value Units
J)third-party payer

Question 44

Match each health insurance term with its definition.
Provider who has contracted with an insurer and accepts whatever the insurance pays as payment in full

A)Advance Beneficiary Notice (ABN)
B)carrier
C)coordination of benefits (COB)
D)fee disclosure
E)fee schedule
F)loss-of-income benefits
G)participating provider
H)patient status
I)Relative Value Units
J)third-party payer

Question 45

Match each health insurance term with its definition.
Insurance company that intervenes to pay hospital or medical bills per contract with the doctor or patient

A)Advance Beneficiary Notice (ABN)
B)carrier
C)coordination of benefits (COB)
D)fee disclosure
E)fee schedule
F)loss-of-income benefits
G)participating provider
H)patient status
I)Relative Value Units
J)third-party payer

Question 46

Match each health insurance term with its definition.
Procedures used by insurers to avoid duplication of payment on claims when the patient has more than one policy

A)Advance Beneficiary Notice (ABN)
B)carrier
C)coordination of benefits (COB)
D)fee disclosure
E)fee schedule
F)loss-of-income benefits
G)participating provider
H)patient status
I)Relative Value Units
J)third-party payer

Question 47

Match each health insurance term with its definition.
Patient's eligibility for benefits

A)Advance Beneficiary Notice (ABN)
B)carrier
C)coordination of benefits (COB)
D)fee disclosure
E)fee schedule
F)loss-of-income benefits
G)participating provider
H)patient status
I)Relative Value Units
J)third-party payer

Question 48

Match each health insurance term with its definition.
When health care providers inform patients of charges before the services are performed

A)Advance Beneficiary Notice (ABN)
B)carrier
C)coordination of benefits (COB)
D)fee disclosure
E)fee schedule
F)loss-of-income benefits
G)participating provider
H)patient status
I)Relative Value Units
J)third-party payer

Question 49

Match each health insurance term with its definition.
List of predetermined payment amounts for professional services provided to patients

A)Advance Beneficiary Notice (ABN)
B)carrier
C)coordination of benefits (COB)
D)fee disclosure
E)fee schedule
F)loss-of-income benefits
G)participating provider
H)patient status
I)Relative Value Units
J)third-party payer

Question 50

Match each health insurance term with its definition.
Payments made to an insured person to help replace income lost through inability to work because of an insured disability

A)Advance Beneficiary Notice (ABN)
B)carrier
C)coordination of benefits (COB)
D)fee disclosure
E)fee schedule
F)loss-of-income benefits
G)participating provider
H)patient status
I)Relative Value Units
J)third-party payer