Chapter 15 study plan
When did the federal government first enact Medicare?
1965
An individual who qualifies for a government health insurance policy is known as a(n) ______.
Beneficiary
This type of risk-based reimbursement pays providers a flat amount per member per month, regardless of what services the patient uses
Capitation
Insurance coverage that provides a member with protection only in times of unexpected, high-cost medical services is which of the following?
Catastrophic care
A(n) ____________ is an example of an out-of-pocket expense that a patient is responsible for paying for health care services.
Deductible
Dillon, a 29-year-old man, used to work in a small company that employed 40 people. He was covered under the company's group health insurance. He quit his job in order to attend a graduate program at a state university. He now needs a new insurance policy but also needs to save enough money to take care of his rent and daily needs. Nevertheless, Dillon purchases a new government health insurance policylong dash—with a high premiumlong dash—three months after quitting his job. In this scenario, which of the following would have been a better alternative?
Dillon should have extended his group health insurance policy from his previous under COBRA, which would have likely been less expensive. This is the correct answer.
The most expensive type of private health insurance plan is usually which of the following
Individual health insurance
Which of the following is correct about Item 12 on the CMS-1500, Patient's or Authorized Person's Signature
It allows the release of any medical information to the insurance company for billing purposes.
Which of the following is considered a disadvantage of managed care?
It has preauthorization requirements.
A medical assistant who is completing the CMS-1500 is unclear about the patient's gender. What should the medical assistant do?
Leave the box for gender blank
Which of the following is a government insurance program designed primarily for low-income people?
Medicaid
A medical assistant will obtain the information necessary to complete "item 10a-c: is patient's condition related to ?" from which of the following source documents?
Medical record and encounter form
Prescription drug coverage is covered in which of the following?
Medicare Part D Your answer is correct.B.
The person who owns the health insurance policy is called the _______.
Member
When did health insurance first begin in the United States?
Mid-1800s
Mr. Raybern, a 50-year-old patient with multiple health conditions. He sees his primary care physician and his endocrinologist on a regular basis. He has been insured under a group medical insurance policy for more than a year. How will the Patient Protection and Affordable Care Act (PPACA) affect Mr. Raybern's medical expenses?
Mr. Raybern will need to pay a higher copayment for a specialist visit than a primary care physician visit.
Which component of the Resource-Based Relative Value Scale (RBRVS) formula corresponds to a dollar amount that is adjusted each year by Medicare?
National uniform conversion factor (CF)
An insurance policyholder pays a(n) ___________ to the insurance carrier to purchase commercials health insurance
Premium
Which of the following regulates property and casualty insurance?
States' Departments of Insurance
Which of the following is not an example of private health insurance?
TRICARE
Which of the following is the least effective way for a professional medical assistant to stay current with health insurance procedures
Talking with patients about their coverage
Why must Medicare patients sign an Advance Beneficiary Notice (ABN)?
Too agree that they will be obligated to pay for a service if Medicare does not cover it
When does an insurance claim begin?
When the patient makes an appointment
Christina, a 30-year-old female patient, underwent a surgical procedure for the removal of a tumor. She has to pay a fixed amount of $20 for every follow-up visit she makes to her surgeon's office. This $20 fee is known as the ________.
copayment
Each of the following is considered the role of a medical assistant in insurance claim processing except
establishing a fee schedule of charges by service.
Another term for an indemnity plan is a(n):
fee-for-service plan.
Preventive care insurance coverage includes:
immunizations
To prevent insurance claim form rejection, the medical assistant should
keep current reference materials, books, and equipment on hand.
Under HIPAA, a patient with a pre-existing condition who changes health plans will:
keep their coverage if they were continuously insured for 24 months prior.
When entering a patient's address on Item 5 of the CMS-1500 form, the medical assistant should:
leave this section blank if the patient's address is the same as the insured's
A patient who has a diagnosis prior to beginning coverage with a new insurance plan is said to have a
preexisting condition
When did health insurance first begin in the United States?
Mid-1800s
Which type of private health insurance plan places money in a reserve fund to pay for employees' medical expenses?
Self-insured health plans
Which of the following statements is incorrect?
Workers' compensation programs are HIPAA-covered entities
