Deck 16: Medical Insurance

Question 1

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.

Answer 1

To verify the patient has coverage and to obtain vital billing information. 

Question 2

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

Answer 2

Fiscal intermediary

Question 3

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

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

Answer 3

Medigap

Question 4

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 5

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

Question 6

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

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 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 9

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 10

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 11

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 12

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 13

An insurance identification card contains the insured person's name, ID number, group number and what other information?

A)telephone number
B)social security number  
C)co-pay amount
D)employers name

Question 14

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 15

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 16

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 17

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

Question 18

If the employer operates its own health plan instead of purchasing a plan from an insurance company to cover its employees, what type of plan are they utilizing?

A)Blue Cross/Blue Shield
B)HMO  
C)Self-Funded Health Care
D)Workers' Compensation

Question 19

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 20

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 21

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

preventive treatment provided

A) managed care
B) traditional

Question 22

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 23

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 24

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

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

Question 25

Which of the following is NOT a category for referrals?

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

Question 26

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 27

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 28

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

annual deductible

A) managed care
B) traditional

Question 29

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

fee-for-service payment

A) managed care
B) traditional

Question 30

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 31

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 32

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 33

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 34

When a person has both Medicare and Medicaid insurance, charges are submitted first to:

A)Medicare, then last to Medicaid 
B)Medicaid only  
C)Medicaid, then to Medicare
D)You can not have both Medicare and Medicaid insurances at the same time

Question 35

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

capitation payment

A) managed care
B) traditional

Question 36

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 37

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

usually can go outside provider network

A) managed care
B) traditional