Question 1

Match the following
-The determination of which health plan will pay for covered services as primary or secondary payer

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

Match the following
-A licensed healthcare professional who has entered into an agreement to provide covered services to covered individuals

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 3

According to the new Patient's Bill of Rights, the following is true regarding emergency care:

Accepted Answer

A)  companies can limit which emergency department the patient goes to. 
B)  new plans cannot penalize for out of network care. 
C)  there may be a financial penalty for non-network care. 
D)  the primary care physician must approve emergency care. 
A)  companies can limit which emergency department the patient goes to. 
B)  new plans cannot penalize for out of network care. 
C)  there may be a financial penalty for non-network care. 
D)  the primary care physician must approve emergency care.

Question 4

Fee schedules in managed care contracts are increasingly based on:

Accepted Answer

A)  Medicare's resource-based relative value scale (RBRVS) and conversion factor. 
B)  Medicare's resource-based relative value scale (RBRVS) with a different conversion factor. 
C)  the HMO's per-member-per-month guidelines. 
D)  usual and customary charges adjusted by geographic area. 
A)  Medicare's resource-based relative value scale (RBRVS) and conversion factor. 
B)  Medicare's resource-based relative value scale (RBRVS) with a different conversion factor. 
C)  the HMO's per-member-per-month guidelines. 
D)  usual and customary charges adjusted by geographic area.

Question 5

Business values incorporated into medical practices as a result of managed care include a(n):

Accepted Answer

A)  emphasis on the doctor-patient relationship. 
B)  return to fee-for-service payments. 
C)  focus on efficiency, cost reduction, and profit. 
D)  focus on administrative requirements and paperwork. 
A)  emphasis on the doctor-patient relationship. 
B)  return to fee-for-service payments. 
C)  focus on efficiency, cost reduction, and profit. 
D)  focus on administrative requirements and paperwork.

Question 6

Determination of which of two or more health plans will provide benefits as primary or secondary payer is known as coordination of benefits.

Accepted Answer

A) True 
 B)False

Question 7

In order to receive National Committee for Quality Assurance (NCQA) accreditation, a managed care organization (MCO) must demonstrate that it has a thorough credentialing process.

Accepted Answer

A) True 
 B)False

Question 8

Contracts between the physician and managed care organization (MCO) are generally negotiated by the:

Accepted Answer

A)  medical office specialist. 
B)  physician or upper management. 
C)  attorney. 
D)  account manager or business manager. 
A)  medical office specialist. 
B)  physician or upper management. 
C)  attorney. 
D)  account manager or business manager.

Question 9

The credentialing process of a managed care organization (MCO) will examine each physician's background for evidence of all of the following EXCEPT:

Accepted Answer

A)  criminal activity. 
B)  disciplinary actions. 
C)  malpractice history. 
D)  salary history. 
A)  criminal activity. 
B)  disciplinary actions. 
C)  malpractice history. 
D)  salary history.

Question 10

Concierge medicine is a small, personalized medical practice that takes care of a limited number of patients.

Accepted Answer

A) True 
 B)False

Question 11

In the Patient's Bill of Rights under the Affordable Care Act, which service(s) are covered with no cost to patients? (Select all that apply)

Accepted Answer

A)  immunizations. 
B)  mammograms. 
C)  chemotherapy. 
D)  colonoscopies. 
A)  immunizations. 
B)  mammograms. 
C)  chemotherapy. 
D)  colonoscopies.

Question 12

A medical office specialist must do all the following EXCEPT:

Accepted Answer

A)  know the Patient Bill of Rights. 
B)  explain the ACO to the patient. 
C)  be familiar with managed care terms. 
D)  promote the provider network. 
A)  know the Patient Bill of Rights. 
B)  explain the ACO to the patient. 
C)  be familiar with managed care terms. 
D)  promote the provider network.

Question 13

The schedule of benefits section of a managed care contract lists the:

Accepted Answer

A)  deductible and coinsurance amounts that patients must pay. 
B)  providers in the contracted network. 
C)  medical services covered under the managed care plan. 
D)  benefits of participating in the managed care plan. 
A)  deductible and coinsurance amounts that patients must pay. 
B)  providers in the contracted network. 
C)  medical services covered under the managed care plan. 
D)  benefits of participating in the managed care plan.

Question 14

Match the following
-Contract issued by a payer under which a covered person may be entitled to covered services

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

Types of payment arrangements in managed care contracts include discounted fee-for-service, per diem, per case, percentage of premiums, and capitation.

Accepted Answer

A) True 
 B)False

Question 16

A provider who enters into a contract with an MCO is referred to as a(n):

Accepted Answer

A)  active provider. 
B)  MCO provider. 
C)  participating provider. 
D)  permanent provider. 
A)  active provider. 
B)  MCO provider. 
C)  participating provider. 
D)  permanent provider.

Question 17

The contract issued by a payer, the plan document, or any other legally enforceable instrument under which a covered person may be entitled to covered services is called:

Accepted Answer

A)  the schedule of benefits. 
B)  the benefit plan. 
C)  covered services. 
D)  contracted services. 
A)  the schedule of benefits. 
B)  the benefit plan. 
C)  covered services. 
D)  contracted services.

Question 18

Under an ACO contract physicians receive a fee for each service they perform.

Accepted Answer

A) True 
 B)False

Question 19

Patients do not have the right to receive emergency services outside of their contracted network.

Accepted Answer

A) True 
 B)False

Question 20

In the Patient's Bill of Rights under the Affordable Health Care Act, young adults who are not offered coverage at work are covered by their parents' plan until they reach:

Accepted Answer

A)  19. 
B)  21. 
C)  25. 
D)  26. 
A)  19. 
B)  21. 
C)  25. 
D)  26.

Match the following -The determination of which health plan will pay for covered services as primary or secondary payer

Match the following -A licensed healthcare professional who has entered into an agreement to provide covered services to covered individuals

According to the new Patient's Bill of Rights, the following is true regarding emergency care:

Fee schedules in managed care contracts are increasingly based on:

Business values incorporated into medical practices as a result of managed care include a(n):

Determination of which of two or more health plans will provide benefits as primary or secondary payer is known as coordination of benefits.

In order to receive National Committee for Quality Assurance (NCQA) accreditation, a managed care organization (MCO) must demonstrate that it has a thorough credentialing process.

Contracts between the physician and managed care organization (MCO) are generally negotiated by the:

The credentialing process of a managed care organization (MCO) will examine each physician's background for evidence of all of the following EXCEPT:

Concierge medicine is a small, personalized medical practice that takes care of a limited number of patients.

In the Patient's Bill of Rights under the Affordable Care Act, which service(s) are covered with no cost to patients? (Select all that apply)

A medical office specialist must do all the following EXCEPT:

The schedule of benefits section of a managed care contract lists the:

Match the following -Contract issued by a payer under which a covered person may be entitled to covered services

Types of payment arrangements in managed care contracts include discounted fee-for-service, per diem, per case, percentage of premiums, and capitation.

A provider who enters into a contract with an MCO is referred to as a(n):

The contract issued by a payer, the plan document, or any other legally enforceable instrument under which a covered person may be entitled to covered services is called:

Under an ACO contract physicians receive a fee for each service they perform.

Patients do not have the right to receive emergency services outside of their contracted network.

In the Patient's Bill of Rights under the Affordable Health Care Act, young adults who are not offered coverage at work are covered by their parents' plan until they reach:

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 -The determination of which health plan will pay for covered services as primary or secondary payer

Match the following -A licensed healthcare professional who has entered into an agreement to provide covered services to covered individuals

According to the new Patient's Bill of Rights, the following is true regarding emergency care:

Fee schedules in managed care contracts are increasingly based on:

Business values incorporated into medical practices as a result of managed care include a(n):

Determination of which of two or more health plans will provide benefits as primary or secondary payer is known as coordination of benefits.

In order to receive National Committee for Quality Assurance (NCQA) accreditation, a managed care organization (MCO) must demonstrate that it has a thorough credentialing process.

Contracts between the physician and managed care organization (MCO) are generally negotiated by the:

The credentialing process of a managed care organization (MCO) will examine each physician's background for evidence of all of the following EXCEPT:

Concierge medicine is a small, personalized medical practice that takes care of a limited number of patients.

In the Patient's Bill of Rights under the Affordable Care Act, which service(s) are covered with no cost to patients? (Select all that apply)

A medical office specialist must do all the following EXCEPT:

The schedule of benefits section of a managed care contract lists the:

Match the following -Contract issued by a payer under which a covered person may be entitled to covered services

Types of payment arrangements in managed care contracts include discounted fee-for-service, per diem, per case, percentage of premiums, and capitation.

A provider who enters into a contract with an MCO is referred to as a(n):

The contract issued by a payer, the plan document, or any other legally enforceable instrument under which a covered person may be entitled to covered services is called:

Under an ACO contract physicians receive a fee for each service they perform.

Patients do not have the right to receive emergency services outside of their contracted network.

In the Patient's Bill of Rights under the Affordable Health Care Act, young adults who are not offered coverage at work are covered by their parents' plan until they reach:

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