AMA Chapter 17 Study Guide
Which of the following best describes policies that are supplementary to Medicare insurance?
Medigap
Which of the following applies to Medicare coverage that pays for outpatient services?
Part B
Which of the following applies to Medicare coverage that pays for prescription drug coverage?
Part D
Which of the following applies to medical insurance for dependents of active duty or retired military personnel and their dependents?
TRICARE
Which of the following is medical insurance for a spouse and unmarried dependent children of a veteran with permanent total disability resulting from a service-related injury?
CHAMPVA
Which of the following is known as the fee system that defines allowable charges that will be accepted by insurance carriers?
UCR
The amount of charges the provider would have to write off if insurance didn't cover it, is know as what?
an adjustment
The amount of money that the insured must incur for medical services before the policy begins to pay is known as what?
deductible
Which of the following applies to a method of containing hospital costs that is based on an average cost of treatment of a patient's condition?
diagnostically related groups
The statement mailed to the patient summarizing how the insurance carrier determined the reimbursement is known as what?
explanation of benefits (EOB)
Which of the following best describes the state or regional organization that handles Medicare claims?
fiscal intermediary
Which of the following traditional insurance coverage covers specific dollar amounts for provider's fees, hospital care, and surgery?
indemnity
Capitation payment
managed care
Preventative treatment provided
managed care
Usually must stay inside the provider network
managed care
Considering the amount that Medicare reimburses for medical care, what amount does the patient and Medicare pay?
patient $12, medicare $48
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 non-HMO providers?
point-of-service plan
Which of the following in not a category for referrals?
post dated
Before certain procedures or visits can be made, some insurance policies require which of the following?
preauthorization
Which of the following best describes a network of providers and hospitals who have a contract with insurance companies to provide discounted health care?
preferred provider organization
Which of the following applies to persons who are eligible for Medicare?
receive disability income
Which is the most common type of referral used by managed care?
regular
Large companies, non-profit organizations, and governments frequently use what kind of insurance to reduce costs and gain more control of their finances?
self-insurance
Health insurance was designed for what reason?
to help individuals and families compensate for high medical costs.
Annual deductible
traditional
Payment fee for service
traditional
Usually can go outside provider network
traditional
Which of the following best describes insurance policies that provide coverage on a fee-for-service basis?
traditional
Which of the following best describes insurance policies that require policy holders to select a primary care provider?
traditional
Which of the following is the purpose of screening new patients for insurance coverage?
verify patient has coverage and obtain vital billing information.
Each time a patient comes to the clinic, the medical assistant must verify which of the following insurance information?
whether insurance covers the procedure, what the patient's insurance plan is, and whether a referral is required. (ALL OF THE ABOVE)
Which of the following is a type of insurance coverage for persons injured on the job?
worker's compensation
Dr. Chad is a participating provider in Medicare. Does this mean Dr. Chard will accept assignment and what percentage of the allowed amount?
yes, 100%
Insurance fraud and abuse may be involved in as many of what percentage of submitted medical claims?
10%
Which of the following is applied to determine primary coverage for a dependent child when both parents are covered by health insurance?
birthday rule
Which of the following terms means an insurance policy pays a percentage of the balance after application of the deductible?
co-insurance.
Which of the following terms is applied when more than one policy covers an individual?
coordination of benefits