Deck 17: Medical Insurance

Question 1

Which of the following best describes insurance policies that provide coverage on a fee-for-service basis?

A) Traditional
B) Group
C) Managed care
D) Indemnity

Answer 1

Traditional

Question 2

Which of the following best describes insurance policies that require policyholders to select a primary care provider?

A) Traditional
B) Group
C) Major medical
D) Indemnity

Answer 2

Traditional

Question 3

Before certain procedures or visits can be made,some insurance policies require which of the following?

A) Preauthorization
B) Predetermination
C) Preregistration
D) Claim review

Answer 3

Preauthorization

Question 4

Which of the following terms is applied when more than one policy covers an individual?

A) Coordination of benefits
B) Co-insurance
C) Co-pay
D) Deductible
E) Birthday rule

Question 5

Large companies,non-profit organizations,and governments frequently use what kind of insurance to reduce costs and gain more control of their finances?

A) Blue Cross/Blue Shield
B) HMO
C) Self-insurance
D) Workers' Compensation

Question 6

Which of the following traditional types of insurance coverage covers specific dollar amounts for provider's fees,hospital care,and surgery?

A) Major medical
B) Individual
C) Group
D) Basic
E) Indemnity

Question 7

Which of the following applies to medical insurance for dependents of active duty or retired military personnel and their dependents?

A) TRICARE
B) SSI
C) CMS
D) HCFA

Question 8

Which of the following applies to persons who are eligible for Medicare?

A) Receive Aid to Dependent Children
B) Receive Supplemental Insurance Income
C) Receive income below the poverty level
D) Receive disability income

Question 9

Which of the following is a type of insurance coverage for persons injured on the job?

A) Major medical
B) Managed care
C) Workers' Compensation
D) Self-insurance

Question 10

Which of the following terms means an insurance policy pays a percentage of the balance after application of the deductible?

A) Coordination of benefits
B) Co-insurance
C) Co-pay
D) Deductible
E) Birthday rule

Question 11

Which of the following applies to Medicare coverage that pays for outpatient services?

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

Question 12

Which of the following is the purpose of screening new patients for insurance coverage?

A) To verify the patient has coverage and to obtain vital billing information.
B) To determine whether the physician is a provider for patient's plan.
C) To determine whether a referral is obtained for services.
D) To ensure the disease is covered by the patient's plan.
E) To ensure the patient understands all provisions of coverage.

Question 13

Which of the following best describes the managed care organization model having the freedom of obtaining medical services from an HMO provider or by self-referral to a non-HMO provider?

A) Health maintenance organization
B) Exclusive provider organization
C) Integrated delivery system
D) Point-of-service plan

Question 14

Health insurance was designed for what reason?

A) To help providers increase their salary
B) To help individuals and families compensate for high medical costs
C) To ensure patients get the best care
D) To increase revenue for the government

Question 15

Which of the following best describes a network of providers and hospitals who have a contract with insurance companies to provide discounted health care?

A) Health maintenance organization
B) Exclusive provider organization
C) Preferred provider organization
D) Integrated delivery system

Question 16

Which of the following best describes policies that are supplementary to Medicare insurance?

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

Question 17

The amount of money that the insured must incur for medical services before the policy begins to pay is known as what?

A) Co-insurance
B) Co-pay
C) Deductible
D) Coordination of benefits

Question 18

Which of the following is applied to determine primary coverage for a dependent child when both parents are covered by health insurance?

A) Coordination of benefits
B) Co-insurance
C) Co-pay
D) Deductible
E) Birthday rule

Question 19

Each time a patient comes to the clinic,the medical assistant must verify which of the following insurance information?

A) Whether insurance covers the procedure
B) Which insurance plan does the patient have
C) Whether a referral is required
D) All of the above

Question 20

Which of the following best describes the state or regional organization that handles Medicare claims?

A) Health maintenance organization
B) Social security office
C) Fiscal intermediary
D) Senior citizens' association

Question 21

Which is the most common type of referral used by managed care?

A) STAT
B) Regular
C) Urgent
D) Post-dated

Question 22

MATCHING
Indicate whether the statements apply to managed care or traditional insurance plans.

usually must stay inside the provider network

A)managed care
B)traditional

Question 23

Considering the amount that Medicare reimburses for medical care,what amount does the patient and Medicare pay?

A) Patient $32; Medicare $48
B) Patient $32; Medicare $42
C) Patient $12; Medicare $48
D) Patient $80; Medicare $0

Question 24

MATCHING
Indicate whether the statements apply to managed care or traditional insurance plans.

usually can go outside provider network

A)managed care
B)traditional

Question 25

Which of the following applies to a method of containing hospital costs that is based on an average cost for treatment of a patient's condition?

A) Capitation
B) Diagnostically related groups
C) Fee-for-service
D) Allowable charges

Question 26

The statement mailed to the patient summarizing how the insurance carrier determined the reimbursement is known as what?

A) (COB) coordination of benefits
B) (SOB) statement of benefits
C) (DOB) determinant of benefits
D) (EOB) explanation of benefits

Question 27

MATCHING
Indicate whether the statements apply to managed care or traditional insurance plans.

preventive treatment provided

A)managed care
B)traditional

Question 28

Which of the following is NOT a category for referrals?

A) Post-dated
B) Regular
C) Urgent
D) STAT

Question 29

Which of the following is known as the fee system that defines allowable charges that will be accepted by insurance carriers?

A) VCR
B) FCR
C) UCR
D) TCR

Question 30

The amount of charges the provider would have to write off if insurance did not cover it,is known as what?

A) Usual customary fee
B) Write-off
C) Deduction
D) Adjustment

Question 31

MATCHING
Indicate whether the statements apply to managed care or traditional insurance plans.

annual deductible

A)managed care
B)traditional

Question 32

Insurance fraud and abuse may be involved in more than what percentage of submitted medical claims?

A) 10%
B) 5%
C) 20%
D) 50%

Question 33

Dr.Chad is a participating provider in Medicare.Does this mean Dr.Chad will accept assignment and what percent of the allowed amount?

A) Yes, 80%
B) Yes, 100%
C) No, 0%
D) None of the above

Question 34

Which of the following applies to Medicare coverage that pays for prescription drugs?

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

Question 35

Which of the following is medical insurance for the spouse and unmarried dependent children of a veteran with permanent total disability resulting from a service-related injury?

A) Medicaid
B) Workers' Compensation
C) TRICARE
D) CHAMPVA

Question 36

MATCHING
Indicate whether the statements apply to managed care or traditional insurance plans.

capitation payment

A)managed care
B)traditional

Question 37

MATCHING
Indicate whether the statements apply to managed care or traditional insurance plans.

fee-for-service payment

A)managed care
B)traditional