Chapter 15 study plan

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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


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