Question 1

Match the following
-A type of HMO in which the MCO contracts with individual physicians and facilities to build the provider network

Accepted Answer

A)  individual practice association (IP
A)  health maintenance organization (HMO) 
B)  staff model health maintenance organization (HMO) 
C)  major medical insurance 
D)  outpatient insurance 
E)  open access health maintenance
F) exclusive provider organization (EPO)
G) point-of-service (POS) plan
H) network model health maintenance organization (HMO)
I) long-term care insurance
J) preferred provider organization (PPO) 
A)  individual practice association (IP
A)  health maintenance organization (HMO) 
B)  staff model health maintenance organization (HMO) 
C)  major medical insurance 
D)  outpatient insurance 
E)  open access health maintenance
F) exclusive provider organization (EPO)
G) point-of-service (POS) plan
H) network model health maintenance organization (HMO)
I) long-term care insurance
J) preferred provider organization (PPO) A

Question 2

Written approval from a managed care plan or insurer given before a patient is admitted to a hospital or receives a particular treatment is known as ________.

Accepted Answer

preauthorization

Question 3

When compared to individual insurance, group insurance provides:

Accepted Answer

A)  fewer benefits and lower costs. 
B)  fewer benefits and higher costs. 
C)  better benefits and higher costs. 
D)  better benefits and lower costs. 
A)  fewer benefits and lower costs. 
B)  fewer benefits and higher costs. 
C)  better benefits and higher costs. 
D)  better benefits and lower costs. D

Question 4

To determine the amount due from a patient, it is necessary to know the:

Accepted Answer

A)  billed amount. 
B)  allowed amount. 
C)  adjusted amount. 
D)  diagnostic code. 
A)  billed amount. 
B)  allowed amount. 
C)  adjusted amount. 
D)  diagnostic code.

Question 5

The type of health maintenance organization (HMO) that contracts with more than one community-based multispecialty group to provide wider geographical coverage is a(n):

Accepted Answer

A)  group model. 
B)  individual practice association (IP
A)  model. 
C)  network model. 
D)  staff model. 
A)  group model. 
B)  individual practice association (IP
A)  model. 
C)  network model. 
D)  staff model.

Question 6

In a managed care organization (MCO) contract, the provider will bill the patient the difference between the standard fee and the contractual or discount amount.

Accepted Answer

A) True 
 B)False

Question 7

Why is knowledge of the history of healthcare in America important for a medical office assistant?

Accepted Answer

This knowledge will assist the

Question 8

Match the following
-The type of managed care plan that combines the features of health maintenance organization (HMO) and preferred provider organization (PPO) plans

Accepted Answer

A)  individual practice association (IP
A)  health maintenance organization (HMO) 
B)  staff model health maintenance organization (HMO) 
C)  major medical insurance 
D)  outpatient insurance 
E)  open access health maintenance
F) exclusive provider organization (EPO)
G) point-of-service (POS) plan
H) network model health maintenance organization (HMO)
I) long-term care insurance
J) preferred provider organization (PPO) 
A)  individual practice association (IP
A)  health maintenance organization (HMO) 
B)  staff model health maintenance organization (HMO) 
C)  major medical insurance 
D)  outpatient insurance 
E)  open access health maintenance
F) exclusive provider organization (EPO)
G) point-of-service (POS) plan
H) network model health maintenance organization (HMO)
I) long-term care insurance
J) preferred provider organization (PPO)

Question 9

All the following are true regarding the Affordable Care Act EXCEPT:

Accepted Answer

A)  It is also known as Obamacare. 
B)  It cannot deny coverage due to a pre-existing condition. 
C)  It offers five different types of government plans. 
D)  It requires people to prove citizenship before receiving services. 
A)  It is also known as Obamacare. 
B)  It cannot deny coverage due to a pre-existing condition. 
C)  It offers five different types of government plans. 
D)  It requires people to prove citizenship before receiving services.

Question 10

The type of health maintenance organization (HMO) plan that involves contracting with individual physicians to create a healthcare delivery system is a(n):

Accepted Answer

A)  group model. 
B)  individual practice association (IP
A)  model. 
C)  network model. 
D)  staff model. 
A)  group model. 
B)  individual practice association (IP
A)  model. 
C)  network model. 
D)  staff model.

Question 11

All the following are true regarding HMOs EXCEPT:

Accepted Answer

A)  regulated by federal and state law. 
B)  encourage preventative health services. 
C)  the least restrictive type of care plan. 
D)  require a referral for specialist services. 
A)  regulated by federal and state law. 
B)  encourage preventative health services. 
C)  the least restrictive type of care plan. 
D)  require a referral for specialist services.

Question 12

The restrictions in a health maintenance organization (HMO) reduce members' premium costs.

Accepted Answer

A) True 
 B)False

Question 13

List three reasons why managed care organizations (MCOs) are criticized.

Accepted Answer

MCOs are criticized for making it diffic

Question 14

Physician-hospital organizations (PHOs) may include:

Accepted Answer

A)  nursing homes. 
B)  laboratories. 
C)  surgery centers. 
D)  all of the above. 
A)  nursing homes. 
B)  laboratories. 
C)  surgery centers. 
D)  all of the above.

Question 15

An insurance identification card usually includes all of the following information EXCEPT:

Accepted Answer

A)  name of the insurance policy. 
B)  name of the subscriber. 
C)  detailed benefit information. 
D)  insurance policy number. 
A)  name of the insurance policy. 
B)  name of the subscriber. 
C)  detailed benefit information. 
D)  insurance policy number.

Question 16

The goals of managed care include all of the following EXCEPT:

Accepted Answer

A)  medical care that is medically necessary and appropriate based on the patient's condition and diagnosis. 
B)  medical care rendered by the most appropriate provider. 
C)  medical care rendered in the most appropriate setting. 
D)  medical care rendered in the most profitable setting. 
A)  medical care that is medically necessary and appropriate based on the patient's condition and diagnosis. 
B)  medical care rendered by the most appropriate provider. 
C)  medical care rendered in the most appropriate setting. 
D)  medical care rendered in the most profitable setting.

Question 17

The federal law that makes it possible for most people to continue their group health coverage for a period of time after leaving a job is called ________.

Accepted Answer

The answer of The federal law that makes it possible...

Question 18

Explain how members see a specialist in a health maintenance organization (HMO) plan.

Accepted Answer

Members can only see

Question 19

Explain the duties of a primary care physician (PCP) in a health maintenance organization (HMO).

Accepted Answer

A PCP (gatekeeper) coordinates

Question 20

Match the following
-The type of insurance that offers protection for large medical expenses beyond the coverage of routine healthcare

Accepted Answer

A)  individual practice association (IP
A)  health maintenance organization (HMO) 
B)  staff model health maintenance organization (HMO) 
C)  major medical insurance 
D)  outpatient insurance 
E)  open access health maintenance
F) exclusive provider organization (EPO)
G) point-of-service (POS) plan
H) network model health maintenance organization (HMO)
I) long-term care insurance
J) preferred provider organization (PPO) 
A)  individual practice association (IP
A)  health maintenance organization (HMO) 
B)  staff model health maintenance organization (HMO) 
C)  major medical insurance 
D)  outpatient insurance 
E)  open access health maintenance
F) exclusive provider organization (EPO)
G) point-of-service (POS) plan
H) network model health maintenance organization (HMO)
I) long-term care insurance
J) preferred provider organization (PPO)

Match the following -A type of HMO in which the MCO contracts with individual physicians and facilities to build the provider network

Written approval from a managed care plan or insurer given before a patient is admitted to a hospital or receives a particular treatment is known as ________.

When compared to individual insurance, group insurance provides:

To determine the amount due from a patient, it is necessary to know the:

The type of health maintenance organization (HMO) that contracts with more than one community-based multispecialty group to provide wider geographical coverage is a(n):

In a managed care organization (MCO) contract, the provider will bill the patient the difference between the standard fee and the contractual or discount amount.

Why is knowledge of the history of healthcare in America important for a medical office assistant?

Match the following -The type of managed care plan that combines the features of health maintenance organization (HMO) and preferred provider organization (PPO) plans

All the following are true regarding the Affordable Care Act EXCEPT:

The type of health maintenance organization (HMO) plan that involves contracting with individual physicians to create a healthcare delivery system is a(n):

All the following are true regarding HMOs EXCEPT:

The restrictions in a health maintenance organization (HMO) reduce members' premium costs.

List three reasons why managed care organizations (MCOs) are criticized.

Physician-hospital organizations (PHOs) may include:

An insurance identification card usually includes all of the following information EXCEPT:

The goals of managed care include all of the following EXCEPT:

The federal law that makes it possible for most people to continue their group health coverage for a period of time after leaving a job is called ________.

Explain how members see a specialist in a health maintenance organization (HMO) plan.

Explain the duties of a primary care physician (PCP) in a health maintenance organization (HMO).

Match the following -The type of insurance that offers protection for large medical expenses beyond the coverage of routine healthcare

Introduction to Professional Billing and Coding Careers

Understanding Managed Care: Medical Contracts and Ethics

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 2: Understanding Managed Care: Insurance Plans

Match the following -A type of HMO in which the MCO contracts with individual physicians and facilities to build the provider network

Written approval from a managed care plan or insurer given before a patient is admitted to a hospital or receives a particular treatment is known as ________.

When compared to individual insurance, group insurance provides:

To determine the amount due from a patient, it is necessary to know the:

The type of health maintenance organization (HMO) that contracts with more than one community-based multispecialty group to provide wider geographical coverage is a(n):

In a managed care organization (MCO) contract, the provider will bill the patient the difference between the standard fee and the contractual or discount amount.

Why is knowledge of the history of healthcare in America important for a medical office assistant?

Match the following -The type of managed care plan that combines the features of health maintenance organization (HMO) and preferred provider organization (PPO) plans

All the following are true regarding the Affordable Care Act EXCEPT:

The type of health maintenance organization (HMO) plan that involves contracting with individual physicians to create a healthcare delivery system is a(n):

All the following are true regarding HMOs EXCEPT:

The restrictions in a health maintenance organization (HMO) reduce members' premium costs.

List three reasons why managed care organizations (MCOs) are criticized.

Physician-hospital organizations (PHOs) may include:

An insurance identification card usually includes all of the following information EXCEPT:

The goals of managed care include all of the following EXCEPT:

The federal law that makes it possible for most people to continue their group health coverage for a period of time after leaving a job is called ________.

Explain how members see a specialist in a health maintenance organization (HMO) plan.

Explain the duties of a primary care physician (PCP) in a health maintenance organization (HMO).

Match the following -The type of insurance that offers protection for large medical expenses beyond the coverage of routine healthcare

Introduction to Professional Billing and Coding Careers

Understanding Managed Care: Medical Contracts and Ethics

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