Question 1

The organization that awards accreditation to managed care organizations is the:

Accepted Answer

A)  Centers for Medicare and Medicaid Services (CMS). 
B)  National Center for Competency Testing (NCCT). 
C)  National Committee for Quality Assurance (NCQ
A) . 
D)  World Health Organization (WHO). 
A)  Centers for Medicare and Medicaid Services (CMS). 
B)  National Center for Competency Testing (NCCT). 
C)  National Committee for Quality Assurance (NCQ
A) . 
D)  World Health Organization (WHO).

Question 2

An individual who is an insured, enrolled subscriber or dependent under the terms of a health benefit plan is a(n):

Accepted Answer

A)  contracted entity. 
B)  covered person. 
C)  payer. 
D)  provider. 
A)  contracted entity. 
B)  covered person. 
C)  payer. 
D)  provider.

Question 3

Which of the following is NOT a common type of payment arrangement in a managed care contract?

Accepted Answer

A)  discounted fee-for-service 
B)  annual fee 
C)  capitation 
D)  per case 
A)  discounted fee-for-service 
B)  annual fee 
C)  capitation 
D)  per case

Question 4

According to some contract terms, if an MCO does not pay a claim within the time limit specified in the contract, the provider may be able to:

Accepted Answer

A)  bill the patient directly. 
B)  charge the usual and customary fee instead of the discounted fee. 
C)  take legal action against the MCO. 
D)  terminate the MCO contract after filing a written notice of intention. 
A)  bill the patient directly. 
B)  charge the usual and customary fee instead of the discounted fee. 
C)  take legal action against the MCO. 
D)  terminate the MCO contract after filing a written notice of intention.

Question 5

In cases of fraudulent billing:

Accepted Answer

A)  only the physician can be held liable. 
B)  the physician can never be held liable. 
C)  the medical office specialist can be held liable. 
D)  the medical office specialist can never be held liable. 
A)  only the physician can be held liable. 
B)  the physician can never be held liable. 
C)  the medical office specialist can be held liable. 
D)  the medical office specialist can never be held liable.

Question 6

A managed care contract will include a:

Accepted Answer

A)  list of patients covered by the plan. 
B)  list of physicians in the network. 
C)  description of what types of employer groups are offered coverage. 
D)  description of how the physician will be paid for services. 
A)  list of patients covered by the plan. 
B)  list of physicians in the network. 
C)  description of what types of employer groups are offered coverage. 
D)  description of how the physician will be paid for services.

Question 7

Under a contract based on a per-case or per-visit rate of compensation, the provider is paid a predetermined rate for each:

Accepted Answer

A)  enrolled patient. 
B)  episode of care. 
C)  diagnosis code. 
D)  service provided. 
A)  enrolled patient. 
B)  episode of care. 
C)  diagnosis code. 
D)  service provided.

Question 8

What types of payment arrangements can be made in managed care contracts?

Accepted Answer

Types of payments arrangements

Question 9

A managed care contract specifies covered services, reimbursement amounts, and the method of ________ for the contracted physician.

Accepted Answer

The answer of A managed care contract specifies covered services,...

Question 10

A medical office specialist works as a liaison between: (Select all that apply)

Accepted Answer

A)  the provider and patient. 
B)  the provider and carrier. 
C)  the patient and employer. 
D)  the employer and carrier. 
A)  the provider and patient. 
B)  the provider and carrier. 
C)  the patient and employer. 
D)  the employer and carrier.

Question 11

Medically necessary services include all of the following EXCEPT services that are:

Accepted Answer

A)  experimental, investigative, or unproven. 
B)  based on recognized standards of the specialty involved. 
C)  not solely for the convenience of a covered person or a healthcare provider. 
D)  accepted by the healthcare profession as appropriate and effective for the condition being treated. 
A)  experimental, investigative, or unproven. 
B)  based on recognized standards of the specialty involved. 
C)  not solely for the convenience of a covered person or a healthcare provider. 
D)  accepted by the healthcare profession as appropriate and effective for the condition being treated.

Question 12

Emergency services are warranted if the absence of immediate medical attention could result in:

Accepted Answer

A)  placing the covered person's health in serious jeopardy. 
B)  serious impairment to bodily functions. 
C)  serious dysfunction of any bodily organ or part. 
D)  all of the above. 
A)  placing the covered person's health in serious jeopardy. 
B)  serious impairment to bodily functions. 
C)  serious dysfunction of any bodily organ or part. 
D)  all of the above.

Question 13

The healthcare professional in a medical practice or billing office who is responsible for submitting insurance claims may be known as a medical office specialist.

Accepted Answer

A) True 
 B)False

Question 14

Match the following
-Healthcare services provided to covered persons under the terms of the benefit plan

Accepted Answer

A)  copayment 
B)  participating provider 
C)  capitation 
D)  contracted services 
E)  payer
F) benefit plan
G) coordination of benefits
H) covered services
I) nonparticipating provider
J) covered person 
A)  copayment 
B)  participating provider 
C)  capitation 
D)  contracted services 
E)  payer
F) benefit plan
G) coordination of benefits
H) covered services
I) nonparticipating provider
J) covered person

Question 15

Match the following
-Covered services provided by a physician that are consistent with the physician's training, licensure, and scope of practice

Accepted Answer

A)  copayment 
B)  participating provider 
C)  capitation 
D)  contracted services 
E)  payer
F) benefit plan
G) coordination of benefits
H) covered services
I) nonparticipating provider
J) covered person 
A)  copayment 
B)  participating provider 
C)  capitation 
D)  contracted services 
E)  payer
F) benefit plan
G) coordination of benefits
H) covered services
I) nonparticipating provider
J) covered person

Question 16

The benefits of a managed care contract to the provider include:

Accepted Answer

A)  keeping costs down. 
B)  bringing more patients to the practice. 
C)  adding opportunities for staff development. 
D)  increasing administrative duties. 
A)  keeping costs down. 
B)  bringing more patients to the practice. 
C)  adding opportunities for staff development. 
D)  increasing administrative duties.

Question 17

Match the following
-An insurance company, third-party administrator, or self-insured health benefit plan that is contractually obligated to make payments on behalf of covered persons

Accepted Answer

A)  copayment 
B)  participating provider 
C)  capitation 
D)  contracted services 
E)  payer
F) benefit plan
G) coordination of benefits
H) covered services
I) nonparticipating provider
J) covered person 
A)  copayment 
B)  participating provider 
C)  capitation 
D)  contracted services 
E)  payer
F) benefit plan
G) coordination of benefits
H) covered services
I) nonparticipating provider
J) covered person

Question 18

A managed care contract is considered a legal document between the:

Accepted Answer

A)  provider and insurer. 
B)  provider and patient. 
C)  patient and insurer. 
D)  insurer and employer. 
A)  provider and insurer. 
B)  provider and patient. 
C)  patient and insurer. 
D)  insurer and employer.

Question 19

Under a discounted fee-for-service arrangement, covered services are compensated at a:

Accepted Answer

A)  discounted per-diem rate. 
B)  per-member-per-month rate. 
C)  reduced percentage of usual and customary charges. 
D)  reduced per-case rate. 
A)  discounted per-diem rate. 
B)  per-member-per-month rate. 
C)  reduced percentage of usual and customary charges. 
D)  reduced per-case rate.

Question 20

Which of the following are new laws in the Patient's Bill of Rights under the Affordable Care Act?

Accepted Answer

A)  no one can be denied coverage because of a pre-existing medical condition. 
B)  a patient cannot be dropped from coverage due to an unintentional mistake on their application. 
C)  insurance companies can no longer put a lifetime limit of the amount of coverage. 
D)  all of the above. 
A)  no one can be denied coverage because of a pre-existing medical condition. 
B)  a patient cannot be dropped from coverage due to an unintentional mistake on their application. 
C)  insurance companies can no longer put a lifetime limit of the amount of coverage. 
D)  all of the above.

The organization that awards accreditation to managed care organizations is the:

An individual who is an insured, enrolled subscriber or dependent under the terms of a health benefit plan is a(n):

Which of the following is NOT a common type of payment arrangement in a managed care contract?

According to some contract terms, if an MCO does not pay a claim within the time limit specified in the contract, the provider may be able to:

In cases of fraudulent billing:

A managed care contract will include a:

Under a contract based on a per-case or per-visit rate of compensation, the provider is paid a predetermined rate for each:

What types of payment arrangements can be made in managed care contracts?

A managed care contract specifies covered services, reimbursement amounts, and the method of ________ for the contracted physician.

A medical office specialist works as a liaison between: (Select all that apply)

Medically necessary services include all of the following EXCEPT services that are:

Emergency services are warranted if the absence of immediate medical attention could result in:

The healthcare professional in a medical practice or billing office who is responsible for submitting insurance claims may be known as a medical office specialist.

Match the following -Healthcare services provided to covered persons under the terms of the benefit plan

Match the following -Covered services provided by a physician that are consistent with the physician's training, licensure, and scope of practice

The benefits of a managed care contract to the provider include:

Match the following -An insurance company, third-party administrator, or self-insured health benefit plan that is contractually obligated to make payments on behalf of covered persons

A managed care contract is considered a legal document between the:

Under a discounted fee-for-service arrangement, covered services are compensated at a:

Which of the following are new laws in the Patient's Bill of Rights under the Affordable Care Act?

Introduction to Professional Billing and Coding Careers

Understanding Managed Care: Insurance Plans

Introduction to the Health Insurance Portability and Accountability Act Hipaa

ICD-10 Cm Medical Coding

Introduction to CPT and Place of Coding Services

Coding Procedures and Services

Hcpcs Coding and Compliance

Auditing

Physician Medical Billing

Hospital Medical Billing

Medicare Medical Billing

Medicaid Medical Billing

Tricare Medical Billing

Explanation of Benefits and Payment Adjudication

Refunds and Appeals

Workers Compensation

Filters

Exam 3: Understanding Managed Care: Medical Contracts and Ethics

The organization that awards accreditation to managed care organizations is the:

An individual who is an insured, enrolled subscriber or dependent under the terms of a health benefit plan is a(n):

Which of the following is NOT a common type of payment arrangement in a managed care contract?

According to some contract terms, if an MCO does not pay a claim within the time limit specified in the contract, the provider may be able to:

In cases of fraudulent billing:

A managed care contract will include a:

Under a contract based on a per-case or per-visit rate of compensation, the provider is paid a predetermined rate for each:

What types of payment arrangements can be made in managed care contracts?

A managed care contract specifies covered services, reimbursement amounts, and the method of ________ for the contracted physician.

A medical office specialist works as a liaison between: (Select all that apply)

Medically necessary services include all of the following EXCEPT services that are:

Emergency services are warranted if the absence of immediate medical attention could result in:

The healthcare professional in a medical practice or billing office who is responsible for submitting insurance claims may be known as a medical office specialist.

Match the following -Healthcare services provided to covered persons under the terms of the benefit plan

Match the following -Covered services provided by a physician that are consistent with the physician's training, licensure, and scope of practice

The benefits of a managed care contract to the provider include:

Match the following -An insurance company, third-party administrator, or self-insured health benefit plan that is contractually obligated to make payments on behalf of covered persons

A managed care contract is considered a legal document between the:

Under a discounted fee-for-service arrangement, covered services are compensated at a:

Which of the following are new laws in the Patient's Bill of Rights under the Affordable Care Act?

Introduction to Professional Billing and Coding Careers

Understanding Managed Care: Insurance Plans

Introduction to the Health Insurance Portability and Accountability Act Hipaa

ICD-10 Cm Medical Coding

Introduction to CPT and Place of Coding Services

Coding Procedures and Services

Hcpcs Coding and Compliance

Auditing

Physician Medical Billing

Hospital Medical Billing

Medicare Medical Billing

Medicaid Medical Billing

Tricare Medical Billing

Explanation of Benefits and Payment Adjudication

Refunds and Appeals

Workers Compensation

Filters