Question 1

​Which of the following statement(s)is/are true?

Accepted Answer

A)  ​When a patient is covered by an indemnity-type plan,most practices will file the claim with the insurance company on the patient's behalf. 
B)  ​When a patient is covered by an HMO,the provider's office files the claim with the insurance company on the patient's behalf. 
C)  ​Providers and suppliers are not required to file the Medicare claim if the service is not covered by Medicare unless the service is provided on an assigned basis and the beneficiary requests the provider to submit the claim 
D)  ​All of the above 
A)  ​When a patient is covered by an indemnity-type plan,most practices will file the claim with the insurance company on the patient's behalf. 
B)  ​When a patient is covered by an HMO,the provider's office files the claim with the insurance company on the patient's behalf. 
C)  ​Providers and suppliers are not required to file the Medicare claim if the service is not covered by Medicare unless the service is provided on an assigned basis and the beneficiary requests the provider to submit the claim 
D)  ​All of the above

Question 2

Match each health insurance term with its definition.
-Term for an insurance company that reimburses for health care services

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 3

Match each health insurance term with its definition.
-Commercial plan in which the insurance company or group reimburses providers or beneficiaries for services

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 4

Match each health insurance term with its definition.
-Insurance purchased by an individual or family who does not have access to group health insurance

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 5

Match each health insurance term with its definition.
-Authorization,by signature of the patient,for payment to be paid directly by the patient's insurance to the provider for services

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)

Question 6

When a patient arrives at the medical office,you should copy (or scan)_____ of the insurance card(s).

Accepted Answer

A)  only the front 
B)  only the back 
C)  both sides 
D)  neither side 
A)  only the front 
B)  only the back 
C)  both sides 
D)  neither side

Question 7

Match each health insurance term with its definition.
-Geographic area served by an insurance carrier

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 8

​Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once.
-​The plan is usually funded by the employee with pretax dollars

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 9

Match each health insurance term with its definition.
-Payments made to an insured person to help replace income lost through inability to work because of an insured disability

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 each health insurance term with its definition.
-Joint funding program by federal and state governments for the medical care of low-income patients on public assistance

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 11

​The ___________________________ is a method of reimbursement in which the Medicare payment for patient services is made based on a predetermined,fixed amount:

Accepted Answer

A)  ​prospective payment system 
B)  ​diagnosis-related group 
C)  ​geographic practice cost index 
D)  ​conversion factor 
A)  ​prospective payment system 
B)  ​diagnosis-related group 
C)  ​geographic practice cost index 
D)  ​conversion factor

Question 12

Match each health insurance term with its definition.
-Numeric values assigned to payment components of the resource-based relative value scale (RBRVS)

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 13

Match each health insurance term with its definition.
-Predetermined amount that the insured must pay each year before the insurance company will pay for an accident or illness

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)

Question 14

​A nonprofit organization created to improve patient care quality and health plan performance in partnership with managed care plans,purchasers,consumers,and the public sector is known as:

Accepted Answer

A)  the Affordable Care Act Compliance department 
B)  ​the Health Insurance Portability and Protection Act (HIPA
A)  
C)  ​the Health Maintenance Organization (HMO) 
D)  ​the National Committee for Quality Assurance (NCQ
A)  
A)  the Affordable Care Act Compliance department 
B)  ​the Health Insurance Portability and Protection Act (HIPA
A)  
C)  ​the Health Maintenance Organization (HMO) 
D)  ​the National Committee for Quality Assurance (NCQ
A)

Question 15

The only practitioners that can currently bill Medicare with the hard-copy CMS-1500s are businesses with:

Accepted Answer

A)  less than 10 full-time employees,including physicians 
B)  more than 20 full-time employees,including physicians 
C)  less than 10 full-time employees,excluding physicians 
D)  more than 20 full-time employees,excluding physicians 
A)  less than 10 full-time employees,including physicians 
B)  more than 20 full-time employees,including physicians 
C)  less than 10 full-time employees,excluding physicians 
D)  more than 20 full-time employees,excluding physicians

Question 16

A provider may not charge a patient for:

Accepted Answer

A)  the part of the deductible that has not been met 
B)  an amount reimbursed after accepting assignment 
C)  any coinsurance that is due 
D)  a service not covered by the patient's insurance 
A)  the part of the deductible that has not been met 
B)  an amount reimbursed after accepting assignment 
C)  any coinsurance that is due 
D)  a service not covered by the patient's insurance

Question 17

The term ____ refers to the discovery of the maximum amount of money that a carrier will pay for primary surgery,consultation services,and so on.

Accepted Answer

A)  precertification 
B)  pretreatment 
C)  preauthorization 
D)  predetermination 
A)  precertification 
B)  pretreatment 
C)  preauthorization 
D)  predetermination

Question 18

Under the birthday rule,if the parents' divorce and retain their plans,the parent with _____ is primary.

Accepted Answer

A)  the greater income 
B)  the plan in effect the longest 
C)  custody 
D)  the parent with the plan that provides the best coverage 
A)  the greater income 
B)  the plan in effect the longest 
C)  custody 
D)  the parent with the plan that provides the best coverage

Question 19

​A health care model defined by CMS as groups of doctors,hospitals,and other health care providers who come together voluntarily to give coordinated high-quality care to Medicare patients is known as:

Accepted Answer

A)  ​the Patient-Centered Medical Home 
B)  the ​Affordable Care Act 
C)  ​the Accountable Care Organization 
D)  ​the Health Maintenance Organization 
A)  ​the Patient-Centered Medical Home 
B)  the ​Affordable Care Act 
C)  ​the Accountable Care Organization 
D)  ​the Health Maintenance Organization

Question 20

Match each health insurance term with its definition.
-Specified amount that the insured must pay toward the charge for professional services rendered at the time of service

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)

Exam 27: Health Insurance

​Which of the following statement(s)is/are true?

Match each health insurance term with its definition. -Term for an insurance company that reimburses for health care services

Match each health insurance term with its definition. -Commercial plan in which the insurance company or group reimburses providers or beneficiaries for services

Match each health insurance term with its definition. -Insurance purchased by an individual or family who does not have access to group health insurance

Match each health insurance term with its definition. -Authorization,by signature of the patient,for payment to be paid directly by the patient's insurance to the provider for services

When a patient arrives at the medical office,you should copy (or scan)_____ of the insurance card(s).

Match each health insurance term with its definition. -Geographic area served by an insurance carrier

​Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once. -​The plan is usually funded by the employee with pretax dollars

Match each health insurance term with its definition. -Payments made to an insured person to help replace income lost through inability to work because of an insured disability

Match each health insurance term with its definition. -Joint funding program by federal and state governments for the medical care of low-income patients on public assistance

​The ___________________________ is a method of reimbursement in which the Medicare payment for patient services is made based on a predetermined,fixed amount:

Match each health insurance term with its definition. -Numeric values assigned to payment components of the resource-based relative value scale (RBRVS)

Match each health insurance term with its definition. -Predetermined amount that the insured must pay each year before the insurance company will pay for an accident or illness

​A nonprofit organization created to improve patient care quality and health plan performance in partnership with managed care plans,purchasers,consumers,and the public sector is known as:

The only practitioners that can currently bill Medicare with the hard-copy CMS-1500s are businesses with:

A provider may not charge a patient for:

The term ____ refers to the discovery of the maximum amount of money that a carrier will pay for primary surgery,consultation services,and so on.

Under the birthday rule,if the parents' divorce and retain their plans,the parent with _____ is primary.

​A health care model defined by CMS as groups of doctors,hospitals,and other health care providers who come together voluntarily to give coordinated high-quality care to Medicare patients is known as:

Match each health insurance term with its definition. -Specified amount that the insured must pay toward the charge for professional services rendered at the time of service

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

Which of the following statement(s)is/are true?

Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once. -The plan is usually funded by the employee with pretax dollars

The ___________________________ is a method of reimbursement in which the Medicare payment for patient services is made based on a predetermined,fixed amount:

A nonprofit organization created to improve patient care quality and health plan performance in partnership with managed care plans,purchasers,consumers,and the public sector is known as:

A health care model defined by CMS as groups of doctors,hospitals,and other health care providers who come together voluntarily to give coordinated high-quality care to Medicare patients is known as: