Question 1

In a(n)_____ plan,patients are able to see specialists without having to obtain referrals from another physician.

Accepted Answer

A)  preferred provider organization (PPO) 
B)  health maintenance organization (HMO) 
C)  independent practice association (IP
A)  
D)  indemnity-type insurance 
A)  preferred provider organization (PPO) 
B)  health maintenance organization (HMO) 
C)  independent practice association (IP
A)  
D)  indemnity-type insurance D

Question 2

Match each health insurance term with its definition.
-Date when an insurance policy goes into effect

Accepted Answer

A) assignment of benefits 
B) TRICARE 
C) CHAMPVA 
D) coordination of benefits (CO
B)  
E) co-payment
F)deductible
G)effective date
H)capitation
I)group insurance
J)health maintenance organization (HMO) 
A) assignment of benefits 
B) TRICARE 
C) CHAMPVA 
D) coordination of benefits (CO
B)  
E) co-payment
F)deductible
G)effective date
H)capitation
I)group insurance
J)health maintenance organization (HMO) G

Question 3

​Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once.
-​The amount can be rolled over from one year to the next

Accepted Answer

A) ​health savings account 
B) ​health reimbursement arrangement 
C) ​flexible spending arrangement 
A) ​health savings account 
B) ​health reimbursement arrangement 
C) ​flexible spending arrangement B

Question 4

When a provider does not accept assignment from Medicare,the most that can be charged to the patient is ___ percent of the Medicare-approved amount.

Accepted Answer

A)  85 
B)  100 
C)  115 
D)  150 
A)  85 
B)  100 
C)  115 
D)  150

Question 5

Match each health insurance term with its definition.
-Patient's eligibility for benefits

Accepted Answer

A) advance beneficiary notice (ABN) 
B) carrier 
C) coordination of benefits (CO
B)  
D) fee disclosure 
E) fee schedule
F)loss-of-income benefits
G)participating provider
H)patient status
I)relative value units
J)third-party payer 
A) advance beneficiary notice (ABN) 
B) carrier 
C) coordination of benefits (CO
B)  
D) fee disclosure 
E) fee schedule
F)loss-of-income benefits
G)participating provider
H)patient status
I)relative value units
J)third-party payer

Question 6

​The traditional type of insurance that once covered the cost of medical care is fast becoming extinct.Even though traditional private insurance is fading,there are still individuals who choose to pay high premiums so that they have the flexibility to seek medical care from health care professionals of their choice.This type of care is still very attractive to many individuals who want the freedom to seek care from any provider and not worry about whether they are remaining in their network,and is known as:

Accepted Answer

A)  ​fee-for-service 
B)  ​preferred provider selection 
C)  ​primary care insurance 
D)  ​none of the above 
A)  ​fee-for-service 
B)  ​preferred provider selection 
C)  ​primary care insurance 
D)  ​none of the above

Question 7

Match each health insurance term with its definition.
-When health care providers inform patients of charges before the services are performed

Accepted Answer

A) advance beneficiary notice (ABN) 
B) carrier 
C) coordination of benefits (CO
B)  
D) fee disclosure 
E) fee schedule
F)loss-of-income benefits
G)participating provider
H)patient status
I)relative value units
J)third-party payer 
A) advance beneficiary notice (ABN) 
B) carrier 
C) coordination of benefits (CO
B)  
D) fee disclosure 
E) fee schedule
F)loss-of-income benefits
G)participating provider
H)patient status
I)relative value units
J)third-party payer

Question 8

​Match the following terms with its definition.
-​Relates not only to whether the services are covered but also whether the proposed treatment is medically necessary

Accepted Answer

A) precertification 
B) ​preauthorization 
C) ​predetermination 
A) precertification 
B) ​preauthorization 
C) ​predetermination

Question 9

Match each health insurance term with its definition.
-Insurance company that intervenes to pay hospital or medical bills per contract with the doctor or patient

Accepted Answer

A) advance beneficiary notice (ABN) 
B) carrier 
C) coordination of benefits (CO
B)  
D) fee disclosure 
E) fee schedule
F)loss-of-income benefits
G)participating provider
H)patient status
I)relative value units
J)third-party payer 
A) advance beneficiary notice (ABN) 
B) carrier 
C) coordination of benefits (CO
B)  
D) fee disclosure 
E) fee schedule
F)loss-of-income benefits
G)participating provider
H)patient status
I)relative value units
J)third-party payer

Question 10

​Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once.
-​Has a high deductible and must be paired with a qualified health plan

Accepted Answer

A) ​health savings account 
B) ​health reimbursement arrangement 
C) ​flexible spending arrangement 
A) ​health savings account 
B) ​health reimbursement arrangement 
C) ​flexible spending arrangement

Question 11

Part ___ of Medicare is for payment of medical expenses such as office visits and X-ray and laboratory services.

Accepted Answer

A)  A 
B)  B 
C)  C 
D)  D 
A)  A 
B)  B 
C)  C 
D)  D

Question 12

​The following health care model is a way of organizing primary care that emphasizes care coordination and communication to transform primary care into "what patients want it to be," and leads to higher quality and lower costs and can improve patients' and providers' experience of care:

Accepted Answer

A)  ​Accountable Care Organization (ACO) 
B)  ​Health Maintenance Organization (HMO) 
C)  ​Patient-Centered Medical Home (PCMH) 
D)  ​all of the above 
A)  ​Accountable Care Organization (ACO) 
B)  ​Health Maintenance Organization (HMO) 
C)  ​Patient-Centered Medical Home (PCMH) 
D)  ​all of the above

Question 13

Match each health insurance term with its definition.
-Person who is insured;an insurance policyholder

Accepted Answer

A) managed care 
B) Medicaid 
C) precertification 
D) preexisting condition 
E) service area
F)subscriber
G)individual insurance
H)indemnity plan
I)utilization management (review)
J)workers' compensation 
A) managed care 
B) Medicaid 
C) precertification 
D) preexisting condition 
E) service area
F)subscriber
G)individual insurance
H)indemnity plan
I)utilization management (review)
J)workers' compensation

Question 14

When patients without health insurance are seen in the medical practice,they are classified as ____ patients.

Accepted Answer

A)  pro bono 
B)  self-pay 
C)  reimbursement 
D)  TRICARE 
A)  pro bono 
B)  self-pay 
C)  reimbursement 
D)  TRICARE

Question 15

​Match the following terms with its definition.
-Refers to the discovery of the maximum amount of money the carrier will pay for primary surgery,consultation service,postoperative care,and so on

Accepted Answer

A) precertification 
B) ​preauthorization 
C) ​predetermination 
A) precertification 
B) ​preauthorization 
C) ​predetermination

Question 16

​Match the Part of Medicare to its definition.Note: Answers may be used more than once.
-​Also known as Medicare Advantage

Accepted Answer

A) ​Part A 
B) ​Part B 
C) ​Part C 
D) ​Part D 
A) ​Part A 
B) ​Part B 
C) ​Part C 
D) ​Part D

Question 17

​In some cases,the Medicare insurance carrier automatically sends the amount not covered on to a private secondary insurance carrier (known as a _______________________),which may pay the deductible and the 20 percent not covered,eliminating the need to fill out additional forms.

Accepted Answer

A)  ​universal claim 
B)  ​secondary claim 
C)  ​crossover claim 
D)  ​none of the above 
A)  ​universal claim 
B)  ​secondary claim 
C)  ​crossover claim 
D)  ​none of the above

Question 18

Match each health insurance term with its definition.
-Provider who has contracted with an insurer and accepts whatever the insurance pays as payment in full

Accepted Answer

A) advance beneficiary notice (ABN) 
B) carrier 
C) coordination of benefits (CO
B)  
D) fee disclosure 
E) fee schedule
F)loss-of-income benefits
G)participating provider
H)patient status
I)relative value units
J)third-party payer 
A) advance beneficiary notice (ABN) 
B) carrier 
C) coordination of benefits (CO
B)  
D) fee disclosure 
E) fee schedule
F)loss-of-income benefits
G)participating provider
H)patient status
I)relative value units
J)third-party payer

Question 19

​Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once.
-​Referred to as a cafeteria plan

Accepted Answer

A) ​health savings account 
B) ​health reimbursement arrangement 
C) ​flexible spending arrangement 
A) ​health savings account 
B) ​health reimbursement arrangement 
C) ​flexible spending arrangement

Question 20

Medicare pays ____ of the approved medical bill amount once the deductible is satisfied.

Accepted Answer

A)  20 
B)  60 
C)  70 
D)  80 
A)  20 
B)  60 
C)  70 
D)  80

Exam 27: Health Insurance

In a(n)_____ plan,patients are able to see specialists without having to obtain referrals from another physician.

Match each health insurance term with its definition. -Date when an insurance policy goes into effect

​Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once. -​The amount can be rolled over from one year to the next

When a provider does not accept assignment from Medicare,the most that can be charged to the patient is ___ percent of the Medicare-approved amount.

Match each health insurance term with its definition. -Patient's eligibility for benefits

Match each health insurance term with its definition. -When health care providers inform patients of charges before the services are performed

​Match the following terms with its definition. -​Relates not only to whether the services are covered but also whether the proposed treatment is medically necessary

Match each health insurance term with its definition. -Insurance company that intervenes to pay hospital or medical bills per contract with the doctor or patient

​Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once. -​Has a high deductible and must be paired with a qualified health plan

Part ___ of Medicare is for payment of medical expenses such as office visits and X-ray and laboratory services.

​The following health care model is a way of organizing primary care that emphasizes care coordination and communication to transform primary care into "what patients want it to be," and leads to higher quality and lower costs and can improve patients' and providers' experience of care:

Match each health insurance term with its definition. -Person who is insured;an insurance policyholder

When patients without health insurance are seen in the medical practice,they are classified as ____ patients.

​Match the following terms with its definition. -Refers to the discovery of the maximum amount of money the carrier will pay for primary surgery,consultation service,postoperative care,and so on

​Match the Part of Medicare to its definition.Note: Answers may be used more than once. -​Also known as Medicare Advantage

​In some cases,the Medicare insurance carrier automatically sends the amount not covered on to a private secondary insurance carrier (known as a _______________________),which may pay the deductible and the 20 percent not covered,eliminating the need to fill out additional forms.

Match each health insurance term with its definition. -Provider who has contracted with an insurer and accepts whatever the insurance pays as payment in full

​Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once. -​Referred to as a cafeteria plan

Medicare pays ____ of the approved medical bill amount once the deductible is satisfied.

The Medical Assistant

The Health Care Team and the Medical Environment,past and Present

Legal Issues

Ethical Issues

Verbal and Nonverbal Communications

Applying Communication Skills

Introduction to Medical Terminology

Understanding and Building Medical Terms of Body Systems

Anatomic Descriptors and Fundamental Body Structure

The Nervous System

The Senses

The Integumentary System

The Skeletal System

The Muscular System

The Respiratory System

The Circulatory System

The Immune System

The Digestive System

The Urinary System

The Endocrine System

The Reproductive System

Telephone Communications

Written Communications

The Office Environment, computers, and Equipment

Scheduling Appointments and Receiving Patients

The Medical Record,documentation,and Filing

A Icd-10 Update: Procedural and Diagnostic Coding

Procedural and Diagnostic Coding

Patient Accounts

Preparing Insurance Claims and Posting Insurance Payments

Patient Billing,posting Patient Payments,and Collecting Fees

Banking Procedures

Accounts Payable and Accounting Procedures

Infection Control and Medical Asepsis

The Medical History and Patient Screening

Body Measurements and Vital Signs

Preparing for Examinations

The Physical Exam

Specialty Exams and Other Procedures

Obgyn Examinations

Pediatric Examinations

The Physicians Office Laboratory

Specimen Collection and Processing

Blood Specimen Collection

Diagnostic Testing

Cardiology Procedures

Radiology Procedures

Preparing for Surgery

Assisting With Minor Surgery

Pharmacology Fundamentals

Measurement Systems,basic Mathematics,and Dosage Calculations

Administering Oral and Non-Injectable Medications

Administering Injections and Immunizations

Emergencies in the Medical Office and the Community

First Aid for Accidents and Injuries

Rehabilitation

Nutrition,exercise,and Healthy Living

Practicum and the Job Search

Managing the Office

Filters

Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once. -The amount can be rolled over from one year to the next

Match the following terms with its definition. -Relates not only to whether the services are covered but also whether the proposed treatment is medically necessary

Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once. -Has a high deductible and must be paired with a qualified health plan

The following health care model is a way of organizing primary care that emphasizes care coordination and communication to transform primary care into "what patients want it to be," and leads to higher quality and lower costs and can improve patients' and providers' experience of care:

Match the following terms with its definition. -Refers to the discovery of the maximum amount of money the carrier will pay for primary surgery,consultation service,postoperative care,and so on

Match the Part of Medicare to its definition.Note: Answers may be used more than once. -Also known as Medicare Advantage

In some cases,the Medicare insurance carrier automatically sends the amount not covered on to a private secondary insurance carrier (known as a _______________________),which may pay the deductible and the 20 percent not covered,eliminating the need to fill out additional forms.

Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once. -Referred to as a cafeteria plan