Question 1

Medigap polices cover which of the following?

Accepted Answer

A)  Difference between major medical reimbursement and patient financial responsibilities 
B)  Difference between Medicare reimbursement and patient financial responsibilities 
C)  Any services not covered under Medicare 
D)  Any services not covered under Major medical 
A)  Difference between major medical reimbursement and patient financial responsibilities 
B)  Difference between Medicare reimbursement and patient financial responsibilities 
C)  Any services not covered under Medicare 
D)  Any services not covered under Major medical B

Question 2

Which of the following is not an advantage of managed care?

Accepted Answer

A)  Healthcare costs are usually contained. 
B)  Access to specialized care and referrals is limited. 
C)  Most preventive medical treatment is covered. 
D)  Out-of-pocket expenses tend to be less than traditional insurance. 
A)  Healthcare costs are usually contained. 
B)  Access to specialized care and referrals is limited. 
C)  Most preventive medical treatment is covered. 
D)  Out-of-pocket expenses tend to be less than traditional insurance. B

Question 3

Veterans of the U.S.armed forces may be covered by

Accepted Answer

A)  CHAMPVA. 
B)  TRICARE. 
C)  workers' compensation. 
D)  Blue Cross/Blue Shield. 
A)  CHAMPVA. 
B)  TRICARE. 
C)  workers' compensation. 
D)  Blue Cross/Blue Shield. A

Question 4

Employee-sponsored group policies usually provide greater benefits at lower premiums because of the large pool of people from whom premiums are collected.However,these employee-sponsored group health insurance plans offer limited benefits,and healthcare access is limited to healthcare providers that are contracted with them.

Accepted Answer

A)  Both statements are true. 
B)  Both statements are false. 
C)  The first statement is true;the second is false. 
D)  The first statement is false;the second is true. 
A)  Both statements are true. 
B)  Both statements are false. 
C)  The first statement is true;the second is false. 
D)  The first statement is false;the second is true.

Question 5

A payment method in which providers are paid for each individual enrolled in a plan,regardless of whether the person sees the provider that month,is called a ______ plan.

Accepted Answer

A)  capitation 
B)  self-insured 
C)  managed care 
D)  fee-for-service 
A)  capitation 
B)  self-insured 
C)  managed care 
D)  fee-for-service

Question 6

If Mr.Jones's insurance has a $500 deductible and a $50 surgery co-pay and then pays 80% of the charges,how much will his policy pay on his bill of $4,359?

Accepted Answer

A)  $3027.20 
B)  $3047.20 
C)  $3047.00 
D)  $3067.50 
A)  $3027.20 
B)  $3047.20 
C)  $3047.00 
D)  $3067.50

Question 7

Most of today's health insurance policies cover which of the following?

Accepted Answer

A)  Preventive care 
B)  Procedures deemed medically necessary 
C)  Elective procedures 
D)  All of the above 
E)  Both A and B 
A)  Preventive care 
B)  Procedures deemed medically necessary 
C)  Elective procedures 
D)  All of the above 
E)  Both A and B

Question 8

Organizations that fund their own insurance programs offer their employees

Accepted Answer

A)  group coverage. 
B)  individual coverage. 
C)  government plans. 
D)  self-funded plans. 
A)  group coverage. 
B)  individual coverage. 
C)  government plans. 
D)  self-funded plans.

Question 9

Dependents of military personnel are covered by which of the following government-sponsored health insurance plans?

Accepted Answer

A)  Medicaid 
B)  Medicare 
C)  TRICARE 
D)  CHAMPVA 
E)  Workers' compensation 
A)  Medicaid 
B)  Medicare 
C)  TRICARE 
D)  CHAMPVA 
E)  Workers' compensation

Question 10

The physician who enters into a contract with an insurance company and agrees to certain rules and regulations is called a ______ provider.

Accepted Answer

A)  participating 
B)  paying 
C)  physician 
D)  None of the above 
A)  participating 
B)  paying 
C)  physician 
D)  None of the above

Question 11

Which part of Medicare covers prescription drug services?

Accepted Answer

A)  A 
B)  B 
C)  C 
D)  D 
A)  A 
B)  B 
C)  C 
D)  D

Question 12

The maximum amount of money third-party payers will pay for a specific procedure or service is called the

Accepted Answer

A)  benefit. 
B)  allowable amount. 
C)  allowed service. 
D)  incurred amount. 
A)  benefit. 
B)  allowable amount. 
C)  allowed service. 
D)  incurred amount.

Question 13

A type of insurance that protects workers from loss of wages after an industrial accident that happened on the job is called

Accepted Answer

A)  an individual policy. 
B)  workers' compensation. 
C)  unemployment insurance. 
D)  disability insurance. 
A)  an individual policy. 
B)  workers' compensation. 
C)  unemployment insurance. 
D)  disability insurance.

Question 14

Which of the following plans require healthcare providers to become participating providers?

Accepted Answer

A)  All government-sponsored health plans 
B)  Most privately sponsored health plans 
C)  Indemnity health insurance plans 
D)  Both A and B 
E)  All of the above 
A)  All government-sponsored health plans 
B)  Most privately sponsored health plans 
C)  Indemnity health insurance plans 
D)  Both A and B 
E)  All of the above

Question 15

The medical assistant should always verify which of the following prior to the patient's appointment?

Accepted Answer

A)  Eligibility 
B)  Benefits and exclusions 
C)  Effective date of insurance 
D)  All of the above 
A)  Eligibility 
B)  Benefits and exclusions 
C)  Effective date of insurance 
D)  All of the above

Question 16

Which of the following individuals would not normally be eligible for Medicare?

Accepted Answer

A)  A 66-year-old retired woman 
B)  A blind teenager 
C)  A 23-year-old recipient of AFDC 
D)  A person on dialysis 
A)  A 66-year-old retired woman 
B)  A blind teenager 
C)  A 23-year-old recipient of AFDC 
D)  A person on dialysis

Question 17

A policy that covers a number of people under a single master contract issued to the employer or to an association with which they are affiliated and that is not self-funded is usually called

Accepted Answer

A)  group policy. 
B)  individual policy. 
C)  a government plan. 
D)  a self-insured plan. 
A)  group policy. 
B)  individual policy. 
C)  a government plan. 
D)  a self-insured plan.

Question 18

Under which of the following Medicare plans for primary care and specialists' services is the patient required to pay a monthly premium?

Accepted Answer

A)  Part A 
B)  Part B 
C)  Part C 
D)  Part D 
A)  Part A 
B)  Part B 
C)  Part C 
D)  Part D

Question 19

Which of the following are not reviewed by a utilization review committee?

Accepted Answer

A)  Physician referrals 
B)  Cases of emergency department visits and urgent care 
C)  Individual cases to ensure medical care services are medically necessary 
D)  Fees for services provided 
A)  Physician referrals 
B)  Cases of emergency department visits and urgent care 
C)  Individual cases to ensure medical care services are medically necessary 
D)  Fees for services provided

Question 20

If Mr.Jones's insurance has a $500 deductible and a $50 surgery co-pay,how much will his insurance pay on his bill of $4,359?

Accepted Answer

A)  $3,809 
B)  $2,809 
C)  $3,980 
D)  $3,900 
A)  $3,809 
B)  $2,809 
C)  $3,980 
D)  $3,900

Exam 16: Basics of Health Insurance

Medigap polices cover which of the following?

Which of the following is not an advantage of managed care?

Veterans of the U.S.armed forces may be covered by

A payment method in which providers are paid for each individual enrolled in a plan,regardless of whether the person sees the provider that month,is called a ______ plan.

If Mr.Jones's insurance has a $500 deductible and a $50 surgery co-pay and then pays 80% of the charges,how much will his policy pay on his bill of $4,359?

Most of today's health insurance policies cover which of the following?

Organizations that fund their own insurance programs offer their employees

Dependents of military personnel are covered by which of the following government-sponsored health insurance plans?

The physician who enters into a contract with an insurance company and agrees to certain rules and regulations is called a ______ provider.

Which part of Medicare covers prescription drug services?

The maximum amount of money third-party payers will pay for a specific procedure or service is called the

A type of insurance that protects workers from loss of wages after an industrial accident that happened on the job is called

Which of the following plans require healthcare providers to become participating providers?

The medical assistant should always verify which of the following prior to the patient's appointment?

Which of the following individuals would not normally be eligible for Medicare?

A policy that covers a number of people under a single master contract issued to the employer or to an association with which they are affiliated and that is not self-funded is usually called

Under which of the following Medicare plans for primary care and specialists' services is the patient required to pay a monthly premium?

Which of the following are not reviewed by a utilization review committee?

If Mr.Jones's insurance has a $500 deductible and a $50 surgery co-pay,how much will his insurance pay on his bill of $4,359?

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The Medical Assistant and the Healthcare Team

Professional Behavior in the Workplace

Therapeutic Communications

Patient Education

Medicine and Law

Medicine and Ethics

Technology and Written Communication in the Medical Office

Telephone Techniques

Scheduling Appointments and Patient Processing

Daily Operations in the Ambulatory Care Setting

The Health Record

Administrative Pharmacology Applications

Basics of Diagnostic Coding

Basics of Procedural Coding

Medical Billing and Reimbursement

Patient Accounts,collections and Practice Management

Banking Services and Procedures

Supervision and Human Resources Management

Medical Practice Marketing and Customer Service

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