Quiz 17: Medical Insurance

Delmars Administrative

Medicine
31
Questions
0
True/False
31
Choices
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Essay
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Questions

Q1
Free

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

Multiple Choice
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A) Whether insurance covers the procedure
B) Which insurance plan does the patient have
C) Whether a referral is required
D) All of the above
Answer:
D) All of the above
Q2
Free

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

Multiple Choice
expand_more
A) To verify the patient has coverage and to obtain vital billing information.
B) To determine whether the physician is a provider for patient's plan.
C) To determine whether a referral is obtained for services.
D) To ensure the disease is covered by the patient's plan.
E) To ensure the patient understands all provisions of coverage.
Answer:
A) To verify the patient has coverage and to obtain vital billing information.
Q3
Free

Health insurance was designed for what reason?

Multiple Choice
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A) To help providers increase their salary
B) To help individuals and families compensate for high medical costs
C) To ensure patients get the best care
D) To increase revenue for the government
Answer:
B) To help individuals and families compensate for high medical costs
Q4

Which of the following terms means an insurance policy pays a percentage of the balance after application of the deductible?

Multiple Choice
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A) Coordination of benefits
B) Co-insurance
C) Co-pay
D) Deductible
E) Birthday rule
Answer:

A) You need to subscribe to get the answer.

Q5

Which of the following terms is applied when more than one policy covers an individual?

Multiple Choice
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A) Coordination of benefits
B) Co-insurance
C) Co-pay
D) Deductible
E) Birthday rule
Answer:

A) You need to subscribe to get the answer.

Q6

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

Multiple Choice
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A) Coordination of benefits
B) Co-insurance
C) Co-pay
D) Deductible
E) Birthday rule
Answer:

A) You need to subscribe to get the answer.

Q7

Which of the following best describes insurance policies that provide coverage on a fee-for-service basis?

Multiple Choice
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A) Traditional
B) Group
C) Managed care
D) Indemnity
Answer:

A) You need to subscribe to get the answer.

Q8

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

Multiple Choice
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A) Major medical
B) Individual
C) Group
D) Basic
E) Indemnity
Answer:

A) You need to subscribe to get the answer.

Q9

Which of the following best describes insurance policies that require policyholders to select a primary care provider?

Multiple Choice
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A) Traditional
B) Group
C) Major medical
D) Indemnity
Answer:

A) You need to subscribe to get the answer.

Q10

Which of the following best describes policies that are supplementary to Medicare insurance?

Multiple Choice
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A) Interim
B) Medicaid
C) TRICARE
D) Medigap
Answer:

A) You need to subscribe to get the answer.

Q11

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

Multiple Choice
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A) Health maintenance organization
B) Social security office
C) Fiscal intermediary
D) Senior citizens' association
Answer:

A) You need to subscribe to get the answer.

Q12

Large companies, non-profit organizations, and governments frequently use what kind of insurance to reduce costs and gain more control of their finances?

Multiple Choice
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A) Blue Cross/Blue Shield
B) HMO
C) Self-insurance
D) Workers' Compensation
Answer:

A) You need to subscribe to get the answer.

Q13

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?

Multiple Choice
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A) Health maintenance organization
B) Exclusive provider organization
C) Integrated delivery system
D) Point-of-service plan
Answer:

A) You need to subscribe to get the answer.

Q14

Which of the following best describes a network of providers and hospitals who have a contract with insurance companies to provide discounted health care?

Multiple Choice
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A) Health maintenance organization
B) Exclusive provider organization
C) Preferred provider organization
D) Integrated delivery system
Answer:

A) You need to subscribe to get the answer.

Q15

The amount of money that the insured must incur for medical services before the policy begins to pay is known as what?

Multiple Choice
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A) Co-insurance
B) Co-pay
C) Deductible
D) Coordination of benefits
Answer:

A) You need to subscribe to get the answer.

Q16

Before certain procedures or visits can be made, some insurance policies require which of the following?

Multiple Choice
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A) Preauthorization
B) Predetermination
C) Preregistration
D) Claim review
Answer:

A) You need to subscribe to get the answer.

Q17

Which of the following applies to Medicare coverage that pays for outpatient services?

Multiple Choice
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A) Part A
B) Part B
C) Part C
D) Part D
Answer:

A) You need to subscribe to get the answer.

Q18

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

Multiple Choice
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A) Major medical
B) Managed care
C) Workers' Compensation
D) Self-insurance
Answer:

A) You need to subscribe to get the answer.

Q19

Which of the following applies to persons who are eligible for Medicare?

Multiple Choice
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A) Receive Aid to Dependent Children
B) Receive Supplemental Insurance Income
C) Receive income below the poverty level
D) Receive disability income
Answer:

A) You need to subscribe to get the answer.

Q20

Which of the following applies to medical insurance for dependents of active duty or retired military personnel and their dependents?

Multiple Choice
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A) TRICARE
B) SSI
C) CMS
D) HCFA
Answer:

A) You need to subscribe to get the answer.

Q21

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?

Multiple Choice
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A) Capitation
B) Diagnostically related groups
C) Fee-for-service
D) Allowable charges
Answer:

A) You need to subscribe to get the answer.

Q22

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?

Multiple Choice
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A) Medicaid
B) Workers' Compensation
C) TRICARE
D) CHAMPVA
Answer:

A) You need to subscribe to get the answer.

Q23

Dr. Chad is a participating provider in Medicare. Does this mean Dr. Chad will accept assignment and what percent of the allowed amount?

Multiple Choice
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A) Yes, 80%
B) Yes, 100%
C) No, 0%
D) None of the above
Answer:

A) You need to subscribe to get the answer.

Q24

Considering the amount that Medicare reimburses for medical care, what amount does the patient and Medicare pay?

Multiple Choice
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A) Patient $32; Medicare $48
B) Patient $32; Medicare $42
C) Patient $12; Medicare $48
D) Patient $80; Medicare $0
Answer:

A) You need to subscribe to get the answer.

Q25

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

Multiple Choice
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A) (COB) coordination of benefits
B) (SOB) statement of benefits
C) (DOB) determinant of benefits
D) (EOB) explanation of benefits
Answer:

A) You need to subscribe to get the answer.

Q26

Which of the following applies to Medicare coverage that pays for prescription drugs?

Multiple Choice
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A) Part A
B) Part B
C) Part C
D) Part D
Answer:

A) You need to subscribe to get the answer.

Q27

Which of the following is NOT a category for referrals?

Multiple Choice
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A) Post-dated
B) Regular
C) Urgent
D) STAT
Answer:

A) You need to subscribe to get the answer.

Q28

Which is the most common type of referral used by managed care?

Multiple Choice
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A) STAT
B) Regular
C) Urgent
D) Post-dated
Answer:

A) You need to subscribe to get the answer.

Q29

Which of the following is known as the fee system that defines allowable charges that will be accepted by insurance carriers?

Multiple Choice
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A) VCR
B) FCR
C) UCR
D) TCR
Answer:

A) You need to subscribe to get the answer.

Q30

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

Multiple Choice
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A) Usual customary fee
B) Write-off
C) Deduction
D) Adjustment
Answer:

A) You need to subscribe to get the answer.

Q31

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

Multiple Choice
expand_more
A) 10%
B) 5%
C) 20%
D) 50%
Answer:

A) You need to subscribe to get the answer.

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