Question 1

How long does a physician have to give a written notice before closing the practice to members of a MCO plan?

Accepted Answer

A)  30-60 days. 
B)  60-90 days. 
C)  3-6 months. 
D)  6-12 months. 
A)  30-60 days. 
B)  60-90 days. 
C)  3-6 months. 
D)  6-12 months.

Question 2

Preferred provider organization (PPO) members pay less out of pocket for medical services from a contracted provider than from a non-network provider.

Accepted Answer

A) True 
 B)False

Question 3

In 2011, what percentage of all U.S. citizens of working age experienced a gap in medical health insurance coverage?

Accepted Answer

A)  13% 
B)  26% 
C)  38% 
D)  49% 
A)  13% 
B)  26% 
C)  38% 
D)  49%

Question 4

The percentage of the provider's fees that the patient has to pay is known as:

Accepted Answer

A)  copayment. 
B)  coinsurance. 
C)  deductible. 
D)  stoploss. 
A)  copayment. 
B)  coinsurance. 
C)  deductible. 
D)  stoploss.

Question 5

Beginning in 2014, employers with 50 or more workers who do not offer coverage will be fined what amount for each employee?

Accepted Answer

A)  $250. 
B)  $500. 
C)  $1,000. 
D)  $2,000. 
A)  $250. 
B)  $500. 
C)  $1,000. 
D)  $2,000.

Question 6

Utilization guidelines are used to:

Accepted Answer

A)  determine if services are medically necessary. 
B)  determine if care is provided by the most appropriate provider. 
C)  determine if the provider is in the network. 
D)  determine if an employee is covered under the plan. 
A)  determine if services are medically necessary. 
B)  determine if care is provided by the most appropriate provider. 
C)  determine if the provider is in the network. 
D)  determine if an employee is covered under the plan.

Question 7

What are some of the ways that managed care organizations (MCOs) create an increased administrative burden on a physician's office?

Accepted Answer

Increased administrative burdens could i

Question 8

The HMO Act of 1973 used federal funds to:

Accepted Answer

A)  promote health maintenance organizations (HMOs). 
B)  increase restrictions on (HMOs). 
C)  develope new managed care corporations. 
D)  establish a regulatory board for (HMOs). 
A)  promote health maintenance organizations (HMOs). 
B)  increase restrictions on (HMOs). 
C)  develope new managed care corporations. 
D)  establish a regulatory board for (HMOs).

Question 9

As the costs of government healthcare programs increased, federal and state governments:

Accepted Answer

A)  increased premiums. 
B)  increased taxes. 
C)  increased deductibles. 
D)  decreased benefits. 
A)  increased premiums. 
B)  increased taxes. 
C)  increased deductibles. 
D)  decreased benefits.

Question 10

At what age can an individual withdraw money from a health savings account (HSA) without penalty?

Accepted Answer

A)  18 
B)  21 
C)  65 
D)  72 
A)  18 
B)  21 
C)  65 
D)  72

Question 11

An integrated delivery system (IDS) is a network of healthcare organizations under a parent holding company.

Accepted Answer

A) True 
 B)False

Question 12

Point-of-service (POS) plans require members to select a primary care physician (PCP).

Accepted Answer

A) True 
 B)False

Question 13

A primary care physician (PCP) in a health maintenance organization (HMO) can be an OB/GYN.

Accepted Answer

A) True 
 B)False

Question 14

It is possible for a health maintenance organization (HMO) member to receive care from a non-network provider or facility in an emergency situation.

Accepted Answer

A) True 
 B)False

Question 15

The Patient Protection and Affordable Care Act requires that all individuals have health insurance beginning in:

Accepted Answer

A)  2012 
B)  2013 
C)  2014 
D)  2015 
A)  2012 
B)  2013 
C)  2014 
D)  2015

Question 16

A goal of managed care is for the patient to receive care in the most appropriate and most restrictive setting.

Accepted Answer

A) True 
 B)False

Question 17

In 2011, the new health care reform law required insurers to offer dependent coverage for adult children up to age ________ so they could be included on their parents' coverage.

Accepted Answer

A)  26 
B)  21 
C)  18 
D)  24 
A)  26 
B)  21 
C)  18 
D)  24

Question 18

The type of policy that would provide coverage for custodial care in a nursing home is:

Accepted Answer

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

Question 19

To avoid the higher costs of healthcare, employers:

Accepted Answer

A)  hired younger employees. 
B)  refused to extend health insurance to employees. 
C)  increased employee premium contributions. 
D)  decreased the number of health plans available to employees. 
A)  hired younger employees. 
B)  refused to extend health insurance to employees. 
C)  increased employee premium contributions. 
D)  decreased the number of health plans available to employees.

Question 20

An individual or facility providing medical care is called the ________.

Accepted Answer

The answer of An individual or facility providing medical care...

How long does a physician have to give a written notice before closing the practice to members of a MCO plan?

Preferred provider organization (PPO) members pay less out of pocket for medical services from a contracted provider than from a non-network provider.

In 2011, what percentage of all U.S. citizens of working age experienced a gap in medical health insurance coverage?

The percentage of the provider's fees that the patient has to pay is known as:

Beginning in 2014, employers with 50 or more workers who do not offer coverage will be fined what amount for each employee?

Utilization guidelines are used to:

What are some of the ways that managed care organizations (MCOs) create an increased administrative burden on a physician's office?

The HMO Act of 1973 used federal funds to:

As the costs of government healthcare programs increased, federal and state governments:

At what age can an individual withdraw money from a health savings account (HSA) without penalty?

An integrated delivery system (IDS) is a network of healthcare organizations under a parent holding company.

Point-of-service (POS) plans require members to select a primary care physician (PCP).

A primary care physician (PCP) in a health maintenance organization (HMO) can be an OB/GYN.

It is possible for a health maintenance organization (HMO) member to receive care from a non-network provider or facility in an emergency situation.

The Patient Protection and Affordable Care Act requires that all individuals have health insurance beginning in:

A goal of managed care is for the patient to receive care in the most appropriate and most restrictive setting.

In 2011, the new health care reform law required insurers to offer dependent coverage for adult children up to age ________ so they could be included on their parents' coverage.

The type of policy that would provide coverage for custodial care in a nursing home is:

To avoid the higher costs of healthcare, employers:

An individual or facility providing medical care is called the ________.

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

How long does a physician have to give a written notice before closing the practice to members of a MCO plan?

Preferred provider organization (PPO) members pay less out of pocket for medical services from a contracted provider than from a non-network provider.

In 2011, what percentage of all U.S. citizens of working age experienced a gap in medical health insurance coverage?

The percentage of the provider's fees that the patient has to pay is known as:

Beginning in 2014, employers with 50 or more workers who do not offer coverage will be fined what amount for each employee?

Utilization guidelines are used to:

What are some of the ways that managed care organizations (MCOs) create an increased administrative burden on a physician's office?

The HMO Act of 1973 used federal funds to:

As the costs of government healthcare programs increased, federal and state governments:

At what age can an individual withdraw money from a health savings account (HSA) without penalty?

An integrated delivery system (IDS) is a network of healthcare organizations under a parent holding company.

Point-of-service (POS) plans require members to select a primary care physician (PCP).

A primary care physician (PCP) in a health maintenance organization (HMO) can be an OB/GYN.

It is possible for a health maintenance organization (HMO) member to receive care from a non-network provider or facility in an emergency situation.

The Patient Protection and Affordable Care Act requires that all individuals have health insurance beginning in:

A goal of managed care is for the patient to receive care in the most appropriate and most restrictive setting.

In 2011, the new health care reform law required insurers to offer dependent coverage for adult children up to age ________ so they could be included on their parents' coverage.

The type of policy that would provide coverage for custodial care in a nursing home is:

To avoid the higher costs of healthcare, employers:

An individual or facility providing medical care is called the ________.

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