Chapter 17: Medical Insurance

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 drugs?

Part D

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 a non-HMO provider?

Point-of-service plan

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

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 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

Health insurance was designed for what reason?

To help individuals and families compensate for high medical costs

Which of the following is the purpose of screening new patients for insurance coverage?

To verify the patient has coverage and to obtain vital billing information.

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 policyholders to select a primary care provider?

Traditional

Each time a patient comes to the clinic, the medical assistant must verify which of the following insurance information?

Whether insurance covers the procedure Which insurance plan does the patient have Whether a referral is required (All of the above)

Which of the following traditional types of insurance coverage covers specific dollar amounts for provider's fees, hospital care, and surgery?

Basic

Which of the following is applied to determine primary coverage for a dependent child when both parents are covered by health insurance?

Birthday rule

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 best describes the state or regional organization that handles Medicare claims?

Fiscal intermediary

The statement mailed to the patient summarizing how the insurance carrier determined the reimbursement is known as what?

(EOB) explanation of benefits

Which of the following is a type of insurance coverage for persons injured on the job?

Workers' Compensation

Insurance fraud and abuse may be involved in more than what percentage of submitted medical claims?

10%

The amount of charges the provider would have to write off if insurance did not cover it, is known as what?

Adjustment