Question 1

The federal and state governments' joint program that funds dental care for certain individuals is called ________.

Accepted Answer

Title XIX, also known as Medicaid, is a joint federal and state program that provides healthcare coverage, including dental care, to eligible low-income individuals and families. It is specifically designed to assist those who cannot afford healthcare on their own.

Question 2

Contractual agreements between practitioners and their insurers to provide dental care services for lower-than-average fees are ________.

Accepted Answer

Preferred Provider Organization (PPO) agreements involve practitioners providing services at reduced fees in exchange for a higher volume of patients.

Question 3

The delivery of dental care in the United States is mostly a private sector endeavor.

Accepted Answer

The majority of dental care in the United States is provided by private dental practices, and the industry is largely privately owned and operated. There are also some public sector dental clinics run by government programs such as Medicaid, but they serve primarily low-income patients.

Question 4

The federal government funds dental care for which of the following target populations?

Accepted Answer

The federal government funds dental care for various target populations including veterans with service-connected disabilities, military personnel, inmates, and Native Americans. Each of these groups has specific programs or policies in place to ensure they receive necessary dental care.

Question 5

Which system is used when a dental provider contracts with a program to provide all or most dental services to the program's subscribers in return for payment on a per-capita basis?

Accepted Answer

Capitation is the system used when a dental provider contracts with a program to provide all or most dental services to the program's subscribers in return for payment on a per-capita basis. Barter involves the exchange of goods or services without the use of money, encounter refers to a single visit or consultation with a healthcare provider, and fee-for-service involves payment for each specific service provided. Therefore, the best choice is C.

Question 6

Federal block grants are usually utilized as preventive block grants and may cover dental services for children.

Accepted Answer

This statement is true. Federal block grants can be used to fund preventive services, including dental services for children.

Question 7

A federal insurance program to pay for medical bills of all people over age 65 is called ________.

Accepted Answer

Medicare is a federal insurance program that covers medical expenses for people over the age of 65, as well as individuals with certain disabilities or illnesses. Medicaid (B) is a state and federal program that provides healthcare coverage to low-income individuals and families. CHIPs (C) stands for Children's Health Insurance Program and provides coverage for children from low-income families. UCR (D) stands for Usual, Customary, and Reasonable, and refers to a method of determining healthcare reimbursement rates for insurance purposes.

Question 8

What is the amount that the insurance entity will pay for covered dental services?

Accepted Answer

The amount the insurance entity will pay for covered dental services is known as the benefit.

Question 9

What form describes benefits to the patient and the provider with accompanying payment or denial of payment?

Accepted Answer

The Explanation of Benefits (EOB) form describes the benefits to the patient and the provider with accompanying payment or denial of payment. It is typically generated by an insurance company or third-party payer after a dental claim has been processed. The Dental Fee Slip and Dental Claim Form may provide information about the services provided, but they do not indicate payment or denial of payment. The Utilization Review Form may be used to evaluate the necessity and appropriateness of dental treatment, but it does not include information about payment.

Question 10

What is the term for the arrangement when fees for services may be decreased depending on the patient's income and family's size?

Accepted Answer

The term for the arrangement when fees for services may be decreased depending on the patient's income and family's size is called sliding scale. This is a common practice in healthcare and social service settings to ensure that all patients receive necessary care regardless of their financial situation. A sliding scale system can help make healthcare more accessible to low-income families and individuals who might otherwise be unable to afford it.

Question 11

A portion of the cost of each service that is paid by the patient is termed ________.

Accepted Answer

A copayment is a fixed amount that a patient pays out of pocket for a particular service or drug. It is typically a small portion of the total cost, and the remaining portion is usually paid by the insurance company.

Question 12

Which payment method is a fee scale per service developed for each service rendered?

Accepted Answer

Fee for service is a payment method that involves charging a fee scale for each service rendered. This means that the healthcare provider is paid for each service they provide, rather than receiving a set amount of money per patient or per month. This method can incentivize providers to offer more services to patients, as they will be compensated for each one, but it can also lead to overutilization of services and higher healthcare costs.

Question 13

State governments generally fund dental services for inmates of federal prisons within their state.

Accepted Answer

Federal prisons are funded and operated by the federal government, which is responsible for providing healthcare services, including dental services, to inmates, not state governments.

Question 14

Funding for public water fluoridation usually falls under the auspices of the local government.

Accepted Answer

Public water fluoridation is typically a decision made and funded by the local government, specifically the water utility department.

Question 15

Local governments may be involved in funding dental care to which target population(s)?

Accepted Answer

The answer of Local governments may be involved in funding...

Question 16

What form is used when a dental provider bills for dental procedures rendered?

Accepted Answer

A dental claim form is used to bill for dental procedures rendered. It includes information such as the patient's identification, the date of service, the procedure performed, and the cost of the procedure.

Question 17

What are legal entities organized for individual participating dental providers to enter into contracts collectively to provide prepaid dental services?

Accepted Answer

Individual Practice Associations (IPAs) are legal entities organized for individual participating providers, including dental providers, to enter into contracts collectively to provide prepaid services. This structure allows individual practitioners to join together for contracting purposes, often with health plans or managed care organizations, while maintaining their separate practices.

Question 18

Which system is used when a patient and a dental provider negotiate payment by exchanging goods and services?

Accepted Answer

The barter system involves the exchange of goods or services without the use of cash or money. In this system, a patient and a dental provider negotiate payment by exchanging goods and services. This system is not commonly used in modern healthcare, but it could be an option in some cases. The other options listed (A, C, D, and E) involve different payment models that are more commonly used in healthcare.

Question 19

What is the range of fees charged by dental providers with similar training and service within a specific and limited geographic area?

Accepted Answer

The term "Customary" refers to the range of fees charged by dental providers with similar training and service within a specific and limited geographic area.

Question 20

A plan that uses the fee-for-service payment method and operates by means of a submittal-and-reimbursement method is called ________.

Accepted Answer

The submittal-and-reimbursement method is a characteristic of the indemnity payment method. With an indemnity plan, the patient pays upfront for healthcare services and then submits a claim to the insurance company for reimbursement. The fee-for-service payment method also aligns with the indemnity plan, where healthcare providers are paid for each service they provide rather than a set amount for the whole package of care. Utilization review, deductible, and capitation do not involve the submittal-and-reimbursement payment method.

Quiz 5: Financing of Dental Care