MED 104 Test

Which of the following is typically documented in the EOB?

Essential info about the submitted claim

Which type of HMO model consists of physicians with separately owned practices who formally organize into a group but continue to practice in their own offices?

independent practice association

Block 1 of the CMS 1500 contains what info?

insured identification number

The physician who enters into a contract with an insurance company and agrees to certain rules and regulations is called a _________ provider

participating

Which of the following pays the hospital surgical room fee?

surgical benefit

Entities that make payment on an obligation or debt but are not parties of the contract that created the debt are called

third party payers

A review of individual cases by a committee to make sure that services are medically necessary and to study how providers use medical care resources is called an

utilization review

The MA should always verify which of the following prior to the patients appt?

verify health insurance coverage

The amount payable by an insurance company for a monetary loss to an individual insured by that company, under each coverage is called the _________.

Benefit

Veterans of the US armed forces may be covered by

CHAMPVA

Which part of Medicare covers prescription drug services?

D

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

IPA

the federal and state sponsored health insurance program for the medically indigent is called the

Medicaid

Which of the following plans require healthcare providers to become participating providers?

PPO

Under which of the following Medicare plans for primary care and specialists services is the patient required to pay a monthly premium?

Part B

Most of todays health insurance policies cover which of the following?

Preventive care

The Federal Tax ID number for the provider filling the claim can be presented as

SSN &EIN

which type of referral is usually processed immediately?

STAT

Which of the following is not an advantage of managed care?

access to specialized care and referrals

the maximum amount of money third party payers will pay for a specific procedure or service is called the

allowed charge

The examine claims for accuracy and completeness before they are submitted is to _______ the claims.

audit

Which of the following is not a disadvantage of managed care?

authorized services are normally covered

The physicians office place of services code is

11

The assignment of benefits is located in block

13

The patients name is found in block

2

Procedures performed on the patient are found in which block?

24d

The physicians signature is located in block

31

The insured name if found in block

4

The secondary health plan is noted in block

9

A policy that covers a number of people under a single master contract issued to the employer or to an association with which they are affiliated and that is not self-funded is usually called

Group coverage

Which of the following MCOS typically have the lowest monthly premiums with lower patient financial responsibility?

Health Maintained Organization

Which of the following HMO models hires physicians and pays them a salary rather that contracting the physicians to create a network?

Staff model

Health insurance designed for military dependents and retired military personnel is called

TRICARE

Which of the following is a fixed amount per visit and is typically paid at the time of medical services?

co payment

The TRICARE option that is similar to a preferred provider network is TRICARE

extra

Which of the following expenses would be paid by Medicare part B?

physician office visits

The insured's address in block 7 refers to the _________ address.

policyholder

Which of the following are not reviewed by a utilization review committee?

pt physician

The amount of money the policyholder pays per claim or per accident toward the total amount of an insured loss before the company will pay on the claim is known as the

remittance

When completing the CMS 1500 form, which section contains info about the pt and the insured?

section 2

Organizations that fund their own insurance programs offer their employees

self funded plan

Health insurance benefits are determined by

service benefit plan