Question 1

The fixed dollar amount a member pays at each office visit or hospital encounter is the:

Accepted Answer

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

Question 2

Point-of-service (POS) plans are becoming more popular because they offer more flexibility and freedom of choice than do standard health maintenance organizations (HMOs).

Accepted Answer

A) True 
 B)False

Question 3

Consolidated Omnibus Reconciliation Act (COBRA) insurance is available to former employees of businesses that have a minimum of:

Accepted Answer

A)  5 employees. 
B)  20 employees. 
C)  50 employees. 
D)  100 employees. 
A)  5 employees. 
B)  20 employees. 
C)  50 employees. 
D)  100 employees.

Question 4

Match the following
-The type of managed care plan that contracts with two or more multispecialty group practices to form a 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)

Question 5

________ is a general term for policies offered through for-profit companies such as Aetna and Prudential.

Accepted Answer

Commercial

Question 6

Advantages of managed care include all of the following EXCEPT:

Accepted Answer

A)  Hospitals and physicians provide services more efficiently. 
B)  Providers strive to improve the quality of their care. 
C)  Physicians run the risk of unfavorable evaluations by enrollees. 
D)  Data is collected and analyzed to measure health outcomes. 
A)  Hospitals and physicians provide services more efficiently. 
B)  Providers strive to improve the quality of their care. 
C)  Physicians run the risk of unfavorable evaluations by enrollees. 
D)  Data is collected and analyzed to measure health outcomes.

Question 7

The duties of a primary care physician (PCP) in a health maintenance organization (HMO) include:

Accepted Answer

A)  acting as a gatekeeper to services. 
B)  coordinating patient care. 
C)  referring patients to specialists. 
D)  all of the above. 
A)  acting as a gatekeeper to services. 
B)  coordinating patient care. 
C)  referring patients to specialists. 
D)  all of the above.

Question 8

Managed care is a system that controls the ________ and ________ of health services to members.

Accepted Answer

cost and d

Question 9

The type of insurance coverage that pays a per diem for each day a patient is in the hospital is:

Accepted Answer

A)  hospital. 
B)  hospital indemnity. 
C)  medical. 
D)  major medical. 
A)  hospital. 
B)  hospital indemnity. 
C)  medical. 
D)  major medical.

Question 10

Medical healthcare coverage cost in 2012 averaged $6,000 per employee.

Accepted Answer

A) True 
 B)False

Question 11

Match the following
-The type of plan that pays benefits only for services provided by network providers but does not have a health maintenance organization (HMO) license

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 12

Primary care physicians (PCPs) are sometimes referred to as gatekeepers because patients with HMO plans must obtain referrals from them in order to see specialists.

Accepted Answer

A) True 
 B)False

Question 13

Which of the following is true of self-insured plans?

Accepted Answer

A)  They are regulated by the Employee Retirement Income Security Act (ERIS
A) . 
B)  They use third-party administrators. 
C)  They assume the financial risk of providing benefits for employees or members. 
D)  They do not abide by state insurance regulations. 
E)  all of the above. 
A)  They are regulated by the Employee Retirement Income Security Act (ERIS
A) . 
B)  They use third-party administrators. 
C)  They assume the financial risk of providing benefits for employees or members. 
D)  They do not abide by state insurance regulations. 
E)  all of the above.

Question 14

As a result of managed care, providers have been required to revamp the way they operate their businesses and their methods of patient care.

Accepted Answer

A) True 
 B)False

Question 15

Terms that refer to fees in an insurance contract include all of the following EXCEPT:

Accepted Answer

A)  customary. 
B)  ordinary. 
C)  reasonable. 
D)  usual. 
A)  customary. 
B)  ordinary. 
C)  reasonable. 
D)  usual.

Question 16

Managed care is a method of controlling healthcare costs and the delivery of care.

Accepted Answer

A) True 
 B)False

Question 17

A(n) ________ model health maintenance organization (HMO) contracts with more than one community-based multispecialty group to provide wider geographical coverage.

Accepted Answer

The answer of A(n) ________ model health maintenance organization (HMO)...

Question 18

Which type of statement signed by the patient authorizes his or her insurance company to send payments directly to the provider?

Accepted Answer

A)  assignment of benefits 
B)  authorization to release protected health information 
C)  advance directive 
D)  beneficiary designation 
A)  assignment of benefits 
B)  authorization to release protected health information 
C)  advance directive 
D)  beneficiary designation

Question 19

Providers who contract with managed care organizations (MCOs) must provide care according to the MCO's policies and guidelines in order to:

Accepted Answer

A)  increase revenue. 
B)  increase patient load. 
C)  be listed in the provider directory. 
D)  be paid for services provided. 
A)  increase revenue. 
B)  increase patient load. 
C)  be listed in the provider directory. 
D)  be paid for services provided.

Question 20

A(n) ________ medical condition is a diagnosis for which the insured has previously been treated and that may not be covered under the terms of some insurance plans.

Accepted Answer

The answer of A(n) ________ medical condition is a diagnosis...

The fixed dollar amount a member pays at each office visit or hospital encounter is the:

Point-of-service (POS) plans are becoming more popular because they offer more flexibility and freedom of choice than do standard health maintenance organizations (HMOs).

Consolidated Omnibus Reconciliation Act (COBRA) insurance is available to former employees of businesses that have a minimum of:

Match the following -The type of managed care plan that contracts with two or more multispecialty group practices to form a provider network

________ is a general term for policies offered through for-profit companies such as Aetna and Prudential.

Advantages of managed care include all of the following EXCEPT:

The duties of a primary care physician (PCP) in a health maintenance organization (HMO) include:

Managed care is a system that controls the and of health services to members.

The type of insurance coverage that pays a per diem for each day a patient is in the hospital is:

Medical healthcare coverage cost in 2012 averaged $6,000 per employee.

Match the following -The type of plan that pays benefits only for services provided by network providers but does not have a health maintenance organization (HMO) license

Primary care physicians (PCPs) are sometimes referred to as gatekeepers because patients with HMO plans must obtain referrals from them in order to see specialists.

Which of the following is true of self-insured plans?

As a result of managed care, providers have been required to revamp the way they operate their businesses and their methods of patient care.

Terms that refer to fees in an insurance contract include all of the following EXCEPT:

Managed care is a method of controlling healthcare costs and the delivery of care.

A(n) ________ model health maintenance organization (HMO) contracts with more than one community-based multispecialty group to provide wider geographical coverage.

Which type of statement signed by the patient authorizes his or her insurance company to send payments directly to the provider?

Providers who contract with managed care organizations (MCOs) must provide care according to the MCO's policies and guidelines in order to:

A(n) ________ medical condition is a diagnosis for which the insured has previously been treated and that may not be covered under the terms of some insurance plans.

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

The fixed dollar amount a member pays at each office visit or hospital encounter is the:

Point-of-service (POS) plans are becoming more popular because they offer more flexibility and freedom of choice than do standard health maintenance organizations (HMOs).

Consolidated Omnibus Reconciliation Act (COBRA) insurance is available to former employees of businesses that have a minimum of:

Match the following -The type of managed care plan that contracts with two or more multispecialty group practices to form a provider network

________ is a general term for policies offered through for-profit companies such as Aetna and Prudential.

Advantages of managed care include all of the following EXCEPT:

The duties of a primary care physician (PCP) in a health maintenance organization (HMO) include:

Managed care is a system that controls the ________ and ________ of health services to members.

The type of insurance coverage that pays a per diem for each day a patient is in the hospital is:

Medical healthcare coverage cost in 2012 averaged $6,000 per employee.

Match the following -The type of plan that pays benefits only for services provided by network providers but does not have a health maintenance organization (HMO) license

Primary care physicians (PCPs) are sometimes referred to as gatekeepers because patients with HMO plans must obtain referrals from them in order to see specialists.

Which of the following is true of self-insured plans?

As a result of managed care, providers have been required to revamp the way they operate their businesses and their methods of patient care.

Terms that refer to fees in an insurance contract include all of the following EXCEPT:

Managed care is a method of controlling healthcare costs and the delivery of care.

A(n) ________ model health maintenance organization (HMO) contracts with more than one community-based multispecialty group to provide wider geographical coverage.

Which type of statement signed by the patient authorizes his or her insurance company to send payments directly to the provider?

Providers who contract with managed care organizations (MCOs) must provide care according to the MCO's policies and guidelines in order to:

A(n) ________ medical condition is a diagnosis for which the insured has previously been treated and that may not be covered under the terms of some insurance plans.

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

Managed care is a system that controls the and of health services to members.