Question 1

An exclusive provider organization (EPO) is similar to a preferred provider organization (PPO) because they both have:

Accepted Answer

A)  a limited provider network. 
B)  gatekeepers. 
C)  payment by capitation. 
D)  a flexible benefit design. 
A)  a limited provider network. 
B)  gatekeepers. 
C)  payment by capitation. 
D)  a flexible benefit design.

Question 2

Match the following
-This type of insurance provides protection for emergency department visits and other outpatient divisions in a hospital or medical facility.

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 3

In a managed care organization (MCO), a primary care physician (PCP) is any of the following EXCEPT:

Accepted Answer

A)  general practitioner. 
B)  family practitioner. 
C)  dermatologist. 
D)  internal medicine doctor. 
A)  general practitioner. 
B)  family practitioner. 
C)  dermatologist. 
D)  internal medicine doctor.

Question 4

The subscriber in a health maintenance organization (HMO) can also be called a(n):

Accepted Answer

A)  employer or policyholder. 
B)  policyholder or member. 
C)  member or provider. 
D)  patient or carrier. 
A)  employer or policyholder. 
B)  policyholder or member. 
C)  member or provider. 
D)  patient or carrier.

Question 5

All health insurance contracts define medical necessity in the same way.

Accepted Answer

A) True 
 B)False

Question 6

The purpose of a withhold program is to:

Accepted Answer

A)  encourage providers to use cost-effective methods. 
B)  reward physicians for ordering extensive tests. 
C)  discourage preventive care. 
D)  promote the use of specialty physicians. 
A)  encourage providers to use cost-effective methods. 
B)  reward physicians for ordering extensive tests. 
C)  discourage preventive care. 
D)  promote the use of specialty physicians.

Question 7

Features of a preferred provider organization (PPO) include which of the following? (Select all that apply)

Accepted Answer

A)  It contracts with healthcare providers to form a network. 
B)  It offers members financial incentives to use network providers. 
C)  It usually rewards providers for managing the cost of care. 
D)  It employs salaried physicians who treat members in facilities it owns and operates. 
A)  It contracts with healthcare providers to form a network. 
B)  It offers members financial incentives to use network providers. 
C)  It usually rewards providers for managing the cost of care. 
D)  It employs salaried physicians who treat members in facilities it owns and operates.

Question 8

Which is true regarding health reimbursement arrangements (HRAs)?

Accepted Answer

A)  unused reimbursements cannot be accessed. 
B)  participation ends upon termination of employment. 
C)  expenses must have incurred during the coverage period. 
D)  the funds cannot be used for dental and vision care. 
A)  unused reimbursements cannot be accessed. 
B)  participation ends upon termination of employment. 
C)  expenses must have incurred during the coverage period. 
D)  the funds cannot be used for dental and vision care.

Question 9

Match the following
-The type of insurance that covers both medical and custodial services

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 10

A physician who coordinates a patient's care and refers patients to specialists is a(n):

Accepted Answer

A)  preferred provider physician (PPP). 
B)  referring gatekeeper. 
C)  primary care physician (PCP). 
D)  primary physician coordinator (PP
C) . 
A)  preferred provider physician (PPP). 
B)  referring gatekeeper. 
C)  primary care physician (PCP). 
D)  primary physician coordinator (PP
C) .

Question 11

Which is true regarding a flexible spending account (FSA)?

Accepted Answer

A)  The money deducted is subject to taxes. 
B)  The money can be withdrawn without penalty. 
C)  Funds are lost when the plan year is over. 
D)  It is used exclusively as a managed care plan. 
A)  The money deducted is subject to taxes. 
B)  The money can be withdrawn without penalty. 
C)  Funds are lost when the plan year is over. 
D)  It is used exclusively as a managed care plan.

Question 12

The type of insurance coverage that provides protection against a specific type of accident or illness is:

Accepted Answer

A)  outpatient. 
B)  major medical. 
C)  special risk. 
D)  catastrophic health insurance. 
A)  outpatient. 
B)  major medical. 
C)  special risk. 
D)  catastrophic health insurance.

Question 13

Which of the following is true of managed care contracts with providers?

Accepted Answer

A)  They are irrevocable by the provider. 
B)  They are irrevocable by the managed care organization (MCO). 
C)  They are usually 1-year contracts. 
D)  Providers must provide a 1-year notice to cancel the contract. 
A)  They are irrevocable by the provider. 
B)  They are irrevocable by the managed care organization (MCO). 
C)  They are usually 1-year contracts. 
D)  Providers must provide a 1-year notice to cancel the contract.

Question 14

If a physician has ordered surgery for a patient, a managed care organization (MCO) case manager may disallow an inpatient stay if the MCO guidelines designate the procedure as best suited for outpatient care.

Accepted Answer

A) True 
 B)False

Question 15

What is the HMO Act of 1973?

Accepted Answer

The HMO Act was signed into la

Question 16

The most restrictive type of managed care plan is the:

Accepted Answer

A)  exclusive provider organization (EPO). 
B)  health maintenance organization (HMO). 
C)  individual practice association (IP
A) . 
D)  preferred provider organization (PPO). 
A)  exclusive provider organization (EPO). 
B)  health maintenance organization (HMO). 
C)  individual practice association (IP
A) . 
D)  preferred provider organization (PPO).

Question 17

Which of the following is true of an exclusive provider organization (EPO)?

Accepted Answer

A)  It is regulated under insurance statutes. 
B)  It is regulated under federal and state health maintenance organization (HMO) regulations. 
C)  Premiums are lower than with a health maintenance organization (HMO). 
D)  Premiums are higher than with a preferred provider organization (PPO). 
A)  It is regulated under insurance statutes. 
B)  It is regulated under federal and state health maintenance organization (HMO) regulations. 
C)  Premiums are lower than with a health maintenance organization (HMO). 
D)  Premiums are higher than with a preferred provider organization (PPO).

Question 18

The type of health maintenance organization (HMO) plan that employs salaried physicians who treat members in facilities owned and operated by the HMO 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 19

The type of insurance that provides coverage for a designated period of time is:

Accepted Answer

A)  medical insurance. 
B)  special risk. 
C)  short-term health insurance. 
D)  long-term care. 
A)  medical insurance. 
B)  special risk. 
C)  short-term health insurance. 
D)  long-term care.

Question 20

A characteristic of a staff model health maintenance organization (HMO) is that it:

Accepted Answer

A)  contracts with a multispecialty physician group. 
B)  is a decentralized healthcare delivery system. 
C)  employs salaried physicians. 
D)  agrees to contractual discounts with physicians. 
A)  contracts with a multispecialty physician group. 
B)  is a decentralized healthcare delivery system. 
C)  employs salaried physicians. 
D)  agrees to contractual discounts with physicians.

An exclusive provider organization (EPO) is similar to a preferred provider organization (PPO) because they both have:

Match the following -This type of insurance provides protection for emergency department visits and other outpatient divisions in a hospital or medical facility.

In a managed care organization (MCO), a primary care physician (PCP) is any of the following EXCEPT:

The subscriber in a health maintenance organization (HMO) can also be called a(n):

All health insurance contracts define medical necessity in the same way.

The purpose of a withhold program is to:

Features of a preferred provider organization (PPO) include which of the following? (Select all that apply)

Which is true regarding health reimbursement arrangements (HRAs)?

Match the following -The type of insurance that covers both medical and custodial services

A physician who coordinates a patient's care and refers patients to specialists is a(n):

Which is true regarding a flexible spending account (FSA)?

The type of insurance coverage that provides protection against a specific type of accident or illness is:

Which of the following is true of managed care contracts with providers?

If a physician has ordered surgery for a patient, a managed care organization (MCO) case manager may disallow an inpatient stay if the MCO guidelines designate the procedure as best suited for outpatient care.

What is the HMO Act of 1973?

The most restrictive type of managed care plan is the:

Which of the following is true of an exclusive provider organization (EPO)?

The type of health maintenance organization (HMO) plan that employs salaried physicians who treat members in facilities owned and operated by the HMO is a(n):

The type of insurance that provides coverage for a designated period of time is:

A characteristic of a staff model health maintenance organization (HMO) is that it:

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

An exclusive provider organization (EPO) is similar to a preferred provider organization (PPO) because they both have:

Match the following -This type of insurance provides protection for emergency department visits and other outpatient divisions in a hospital or medical facility.

In a managed care organization (MCO), a primary care physician (PCP) is any of the following EXCEPT:

The subscriber in a health maintenance organization (HMO) can also be called a(n):

All health insurance contracts define medical necessity in the same way.

The purpose of a withhold program is to:

Features of a preferred provider organization (PPO) include which of the following? (Select all that apply)

Which is true regarding health reimbursement arrangements (HRAs)?

Match the following -The type of insurance that covers both medical and custodial services

A physician who coordinates a patient's care and refers patients to specialists is a(n):

Which is true regarding a flexible spending account (FSA)?

The type of insurance coverage that provides protection against a specific type of accident or illness is:

Which of the following is true of managed care contracts with providers?

If a physician has ordered surgery for a patient, a managed care organization (MCO) case manager may disallow an inpatient stay if the MCO guidelines designate the procedure as best suited for outpatient care.

What is the HMO Act of 1973?

The most restrictive type of managed care plan is the:

Which of the following is true of an exclusive provider organization (EPO)?

The type of health maintenance organization (HMO) plan that employs salaried physicians who treat members in facilities owned and operated by the HMO is a(n):

The type of insurance that provides coverage for a designated period of time is:

A characteristic of a staff model health maintenance organization (HMO) is that it:

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