Question 1

Match the following
-A provider who is not under contract with a managed care 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 2

Managed care contracts never prohibit the provider from seeking payment directly from plan members.

Accepted Answer

A) True 
 B)False

Question 3

Match the following
-An individual who is an insured, enrolled participant or enrolled dependent under a 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 4

The charge a covered person is required to pay at the time covered services are provided is called a(n) ________.

Accepted Answer

The answer of The charge a covered person is required...

Question 5

A policyholder in a managed care contract is also called a member or enrollee.

Accepted Answer

A) True 
 B)False

Question 6

An increasing number of managed care plans are basing fee schedules on the Medicare ________.

Accepted Answer

resource-b

Question 7

Principles adopted in the Patient's Bill of Rights include all of the following EXCEPT the right to:

Accepted Answer

A)  accurate and easily understood information. 
B)  receive emergency services without penalty. 
C)  know your treatment options. 
D)  sue the managed care organization. 
A)  accurate and easily understood information. 
B)  receive emergency services without penalty. 
C)  know your treatment options. 
D)  sue the managed care organization.

Question 8

The organization that awards accreditation to health plans for meeting quality standards of healthcare delivery is the ________.

Accepted Answer

National C

Question 9

All of the following are true regarding the concierge contract EXCEPT:

Accepted Answer

A)  It may not be required to abide by the Bill of Rights. 
B)  It is a legal agreement between patient and provider. 
C)  It is a cash only agreement between the provider and patient. 
D)  It may require the patient to pay the provider a retainer. 
A)  It may not be required to abide by the Bill of Rights. 
B)  It is a legal agreement between patient and provider. 
C)  It is a cash only agreement between the provider and patient. 
D)  It may require the patient to pay the provider a retainer.

Question 10

The list of medical services covered under the insured's policy is called the schedule of ________.

Accepted Answer

The answer of The list of medical services covered under...

Question 11

Why are managed care organizations (MCOs) evaluating and grading network physicians on the services they provide?

Accepted Answer

MCOs want their policyholders to be sati

Question 12

The following is true of Obamacare:

Accepted Answer

A)  preventative care is more accessible. 
B)  employers are mandated to furnish healthcare or be fined. 
C)  requires all insurance plans to cover contraceptives at no cost. 
D)  all of the above. 
A)  preventative care is more accessible. 
B)  employers are mandated to furnish healthcare or be fined. 
C)  requires all insurance plans to cover contraceptives at no cost. 
D)  all of the above.

Question 13

Under an ACO the member can use any doctor or hospital that accepts Medicare.

Accepted Answer

A) True 
 B)False

Question 14

A contract with which of the following payment terms can result in an increased financial risk to the provider?

Accepted Answer

A)  capitation 
B)  percentage of premiums 
C)  fee-for-service 
D)  discounted fee-for-service 
A)  capitation 
B)  percentage of premiums 
C)  fee-for-service 
D)  discounted fee-for-service

Question 15

Most managed care contracts allow an unlimited time frame for submitting claims.

Accepted Answer

A) True 
 B)False

Question 16

Which of the following is true of the new Patient's Bill of Rights under the Affordable Health Care Act?

Accepted Answer

A)  Insurance companies are banned from restricting emergency room care. 
B)  Insurance companies are prohibited from charging patients for preventative care. 
C)  Insurance companies are banned from limiting choice of doctors. 
D)  all of the above. 
A)  Insurance companies are banned from restricting emergency room care. 
B)  Insurance companies are prohibited from charging patients for preventative care. 
C)  Insurance companies are banned from limiting choice of doctors. 
D)  all of the above.

Question 17

List the basic provisions of a managed care contract.

Accepted Answer

The contract outlines what is

Question 18

A medical office specialist should always document, sign, and date all conversations regarding any patient's account.

Accepted Answer

A) True 
 B)False

Question 19

An MCO may contract with a physician whose background is questionable in order to:

Accepted Answer

A)  contract with all the providers in a given area. 
B)  make the network as large as possible. 
C)  ensure that all specialties are available in the network. 
D)  An MCO would never contract with a physician who has a questionable reputation. 
A)  contract with all the providers in a given area. 
B)  make the network as large as possible. 
C)  ensure that all specialties are available in the network. 
D)  An MCO would never contract with a physician who has a questionable reputation.

Question 20

Services provided to treat a medical condition that involves the sudden onset of acute symptoms of sufficient severity to threaten a person's life or health are:

Accepted Answer

A)  urgent care. 
B)  medical care. 
C)  hospital care. 
D)  emergency care. 
A)  urgent care. 
B)  medical care. 
C)  hospital care. 
D)  emergency care.

Match the following -A provider who is not under contract with a managed care plan

Managed care contracts never prohibit the provider from seeking payment directly from plan members.

Match the following -An individual who is an insured, enrolled participant or enrolled dependent under a benefit plan

The charge a covered person is required to pay at the time covered services are provided is called a(n) ________.

A policyholder in a managed care contract is also called a member or enrollee.

An increasing number of managed care plans are basing fee schedules on the Medicare ________.

Principles adopted in the Patient's Bill of Rights include all of the following EXCEPT the right to:

The organization that awards accreditation to health plans for meeting quality standards of healthcare delivery is the ________.

All of the following are true regarding the concierge contract EXCEPT:

The list of medical services covered under the insured's policy is called the schedule of ________.

Why are managed care organizations (MCOs) evaluating and grading network physicians on the services they provide?

The following is true of Obamacare:

Under an ACO the member can use any doctor or hospital that accepts Medicare.

A contract with which of the following payment terms can result in an increased financial risk to the provider?

Most managed care contracts allow an unlimited time frame for submitting claims.

Which of the following is true of the new Patient's Bill of Rights under the Affordable Health Care Act?

List the basic provisions of a managed care contract.

A medical office specialist should always document, sign, and date all conversations regarding any patient's account.

An MCO may contract with a physician whose background is questionable in order to:

Services provided to treat a medical condition that involves the sudden onset of acute symptoms of sufficient severity to threaten a person's life or health are:

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

Match the following -A provider who is not under contract with a managed care plan

Managed care contracts never prohibit the provider from seeking payment directly from plan members.

Match the following -An individual who is an insured, enrolled participant or enrolled dependent under a benefit plan

The charge a covered person is required to pay at the time covered services are provided is called a(n) ________.

A policyholder in a managed care contract is also called a member or enrollee.

An increasing number of managed care plans are basing fee schedules on the Medicare ________.

Principles adopted in the Patient's Bill of Rights include all of the following EXCEPT the right to:

The organization that awards accreditation to health plans for meeting quality standards of healthcare delivery is the ________.

All of the following are true regarding the concierge contract EXCEPT:

The list of medical services covered under the insured's policy is called the schedule of ________.

Why are managed care organizations (MCOs) evaluating and grading network physicians on the services they provide?

The following is true of Obamacare:

Under an ACO the member can use any doctor or hospital that accepts Medicare.

A contract with which of the following payment terms can result in an increased financial risk to the provider?

Most managed care contracts allow an unlimited time frame for submitting claims.

Which of the following is true of the new Patient's Bill of Rights under the Affordable Health Care Act?

List the basic provisions of a managed care contract.

A medical office specialist should always document, sign, and date all conversations regarding any patient's account.

An MCO may contract with a physician whose background is questionable in order to:

Services provided to treat a medical condition that involves the sudden onset of acute symptoms of sufficient severity to threaten a person's life or health are:

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