CHAPTER 2 - Health Insurance (QUIZ)

A type of insurance that protects workers from loss of wages after an industrial accident that happened on the job is called: an individual policy. workers' compensation. unemployment insurance. disability insurance.

workers' compensation.

The federal- and state-sponsored health insurance program for the medically indigent is called: Medicare. Medicaid. Medigap. MediCal.

Medicaid.

Which part of Medicare covers inpatient hospital charges? Part A Part B Part C Part D

Part A

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

Part B

Which of the following expenses would be paid by Medicare Part B? Inpatient hospital charges Hospice services Physician's office visits Home healthcare charges

Physician's office visits

Most of today's health insurance policies cover which of the following? Preventive care Procedures deemed medically necessary Elective procedures All are correct Preventive care and procedures deemed medically necessary

Preventive care and procedures deemed medically necessary

Which type of referral is usually processed immediately? Regular Urgent STAT All are correct

STAT

Which of the following referrals can be approved online when it is submitted through the provider's web portal to the utilization review department? Regular referral Urgent referral STAT referral All are correct

STAT referral

Health insurance designed for military dependents and retired military personnel is called: CHAMPVA. TRICARE. Medicare. Medicaid.

TRICARE.

A designated person who receives funds from an insurance policy is: beneficiary. claimant. gatekeeper. indigent.

beneficiary.

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: explanation of benefits. fee schedule. claim. policy.

explanation of benefits.

A list of the fixed fees for services is a: explanation of benefits. fee schedule. claim. policy.

fee schedule.

In some managed care plans referrals to a specialist must be approved by the: beneficiary. gatekeeper. third-party administrator. policyholder.

gatekeeper.

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. capitation self-insured managed care fee-for-service

capitation

A formal request for payment from an insurance company for services provided is: explanation of benefits. fee schedule. claim. policy.

claim.

A certain percentage of the allowed amount that the policyholder is responsible for is: premium. deductible. copayment. co-insurance.

co-insurance.

A set dollar amount that the policyholder must pay for each office visit is: premium. deductible. copayment. co-insurance.

copayment.

The amount of money the policyholder pays per claim before the insurance company will pay on the claim is known as the: exclusion. premium. deductible. remittance.

deductible.

A policy that covers a number of people under a single contract issued to the employer: group policy. individual policy. a government plan. a self-insured plan.

group policy.

Someone who is poor, needy, or impoverished is considered: uninsurable. a cash only patient. indigent. None are correct

indigent.

Services that are needed to improve the patient's current health are considered: elective. preventive. medically necessary. provider network.

medically necessary.

The provider who enters into a contract with an insurance company and agrees to certain rules and regulations is called a ______ provider. participating paying provider None are correct

participating

A written agreement between two parties, where one party agrees to pay another party if certain specified circumstances occur is a: policy. preauthorization. referral. fee schedule.

policy.

A process required by some insurance carriers in which the provider obtains permission to perform certain procedures or services is: preauthorization. referral. utilization management. None are correct

preauthorization.

The amount of money paid to keep an insurance policy in force is the: premium. deductible. copayment. co-insurance.

premium.

Service provided to stop certain conditions from occurring or to lead to an early diagnosis are considered: elective. preventive. medically necessary. provider network.

preventive.

An approved list of physicians, hospitals, and other providers is a(n): explanation of benefits. health insurance exchange. third-party administrator. provider network.

provider network.

An order from a primary care provider for the patient to see a specialist is a(n): preauthorization. policy. referral. health insurance exchange.

referral.

Organizations that fund their own insurance programs offer their employees: group coverage. individual coverage. government plans. self-funded plans.

self-funded plans.

A review of individual cases by a committee to make sure that services are medically necessary is called a(n): credentialing committee review. peer review committee evaluation. utilization review. audit committee review.

utilization review.

Medigap polices cover which of the following? Medicare deductible Medicare co-insurance Services not covered under Medicare All are correct

All are correct

The medical assistant should always verify which of the following prior to the patient's appointment? Eligibility Benefits and exclusions Effective date of insurance All are correct

All are correct

Which of the following managed care plans require preauthorization for medical services such as surgery? HMOs PPOs EPOs HMOs and PPOs All are correct

All are correct

Which of the following plans require healthcare providers to become participating providers? All government-sponsored health plans Most privately sponsored health plans Indemnity health insurance plans All government-sponsored health plans and most privately sponsored health plans All are correct

All government-sponsored health plans and most privately sponsored health plans

Veterans of the U.S. armed forces may be covered by: CHAMPVA. TRICARE. workers' compensation. Blue Cross/Blue Shield.

CHAMPVA.

Which part of Medicare covers prescription drug services? A B C D

D

Which of the following are not reviewed by a utilization review committee? Provider referrals Cases of emergency department visits and urgent care Individual cases to ensure medical care services are medically necessary Fees for services provided

Fees for services provided

Which of the following MCOs typically has/have the lowest monthly premiums with lower patient financial responsibility? Medicare/Medicaid PPOs HMOs BC/BS IPA

HMOs