Question 1

MATCHING
Indicate whether the statements apply to managed care or traditional insurance plans.

-fee-for-service payment

Accepted Answer

A)  managed care
B)  traditionalC) A) and B)
D) undefined

Question 2

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

Accepted Answer

A)   Receive Aid to Dependent Children
B)   Receive Supplemental Insurance Income
C)   Receive income below the poverty level
D)   Receive disability incomeE) B) and C)
F) A) and D)

Question 3

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

Accepted Answer

A)   Blue Cross/Blue Shield
B)   HMO
C)   Self-insurance
D)   Workers' CompensationE) A) and D)
F) A) and C) C

Question 4

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

Accepted Answer

A)   Whether insurance covers the procedure
B)   Which insurance plan does the patient have
C)   Whether a referral is required
D)   All of the aboveE) None of the above
F) A) and B)

Question 5

MATCHING
Indicate whether the statements apply to managed care or traditional insurance plans.

-preventive treatment provided

Accepted Answer

A)  managed care
B)  traditionalC) A) and B)
D) undefined A

Question 6

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

Accepted Answer

A)   Patient $32; Medicare $48
B)   Patient $32; Medicare $42
C)   Patient $12; Medicare $48
D)   Patient $80; Medicare $0E) None of the above
F) B) and C)

Question 7

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

Accepted Answer

A)   Co-insurance
B)   Co-pay
C)   Deductible
D)   Coordination of benefitsE) A) and B)
F) None of the above

Question 8

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

Accepted Answer

A)   Part A
B)   Part B
C)   Part C
D)   Part DE) A) and B)
F) C) and D)

Question 9

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

Accepted Answer

A)   (CO
B)   coordination of benefits
B)   (SO
B)   statement of benefits
C)   (DO
B)   determinant of benefits
D)   (EO
B)   explanation of benefitsE) A) and C)
F) None of the above

Question 10

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

Accepted Answer

A)   Health maintenance organization
B)   Social security office
C)   Fiscal intermediary
D)   Senior citizens' associationE) C) and D)
F) A) and B)

Question 11

MATCHING
Indicate whether the statements apply to managed care or traditional insurance plans.

-usually must stay inside the provider network

Accepted Answer

A)  managed care
B)  traditionalC) A) and B)
D) undefined

Question 12

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

Accepted Answer

A)   Coordination of benefits
B)   Co-insurance
C)   Co-pay
D)   Deductible
E)   Birthday ruleF) A) and B)
G) A) and C)

Question 13

MATCHING
Indicate whether the statements apply to managed care or traditional insurance plans.

-usually can go outside provider network

Accepted Answer

A)  managed care
B)  traditionalC) A) and B)
D) undefined

Question 14

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

Accepted Answer

A)   Major medical
B)   Individual
C)   Group
D)   Basic
E)   IndemnityF) C) and D)
G) A) and E)

Question 15

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

Accepted Answer

A)   Traditional
B)   Group
C)   Managed care
D)   IndemnityE) A) and D)
F) A) and C)

Question 16

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

Accepted Answer

A)   Yes, 80%
B)   Yes, 100%
C)   No, 0%
D)   None of the aboveE) None of the above
F) A) and D)

Question 17

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?

Accepted Answer

A)   Capitation
B)   Diagnostically related groups
C)   Fee-for-service
D)   Allowable chargesE) All of the above
F) None of the above

Question 18

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

Accepted Answer

A)   10%
B)   5%
C)   20%
D)   50%E) All of the above
F) B) and C)

Question 19

Health insurance was designed for what reason?

Accepted Answer

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 governmentE) C) and D)
F) B) and D) B

Question 20

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

Accepted Answer

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.F) All of the above
G) B) and C)

Exam 17: Medical Insurance

MATCHING Indicate whether the statements apply to managed care or traditional insurance plans. -fee-for-service payment

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedC

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

Correct AnswerverifiedShow Answer

MATCHING Indicate whether the statements apply to managed care or traditional insurance plans. -preventive treatment provided

Correct AnswerverifiedA

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

MATCHING Indicate whether the statements apply to managed care or traditional insurance plans. -usually must stay inside the provider network

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

MATCHING Indicate whether the statements apply to managed care or traditional insurance plans. -usually can go outside provider network

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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?

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

Health insurance was designed for what reason?

Correct AnswerverifiedB

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

Correct AnswerverifiedShow Answer

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C

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A

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B

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