MOP Chapter 16 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 is 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
If the employer operates its own health plan instead of purchasing a plan from an insurance company to cover its employees, what type of plan are they utilizing?
Self-Funded Health Care
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 the spouse and unmarried dependent children of a veteran with permanent total disability resulting from a service-related injury?
CHAMPVA
Which of the following terms is applied when more than one policy covers an individual?
Coordination of benefits
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 require policyholders to select a primary care provider?
Traditional
Which of the following is known as the fee system that defines allowable charges that will be accepted by insurance carriers?
UCR
Dr. Chad is a participating provider in Medicare. Does this mean Dr. Chad will accept assignment and what percent of the allowed amount?
Yes, 100%
Which of the following traditional types of insurance coverage covers specific dollar amounts for provider's fees, hospital care, and surgery?
Basic
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 for treatment of a patient's condition?
Diagnostically related groups
Which of the following best describes the state or regional organization that handles Medicare claims?
Fiscal intermediary
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
