Question 1

Match each health insurance term with its definition.
-List of predetermined payment amounts for professional services provided to patients

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 2

​Which type of insurance does not require a referral for patient care and specialists?

Accepted Answer

A)  ​indemnity-type insurance 
B)  ​health maintenance organization 
C)  ​preferred provider organization 
D)  ​all require a referral to see a specialist or another provider 
A)  ​indemnity-type insurance 
B)  ​health maintenance organization 
C)  ​preferred provider organization 
D)  ​all require a referral to see a specialist or another provider

Question 3

Match each health insurance term with its definition.
-A form of insurance providing wage replacement and medical benefits to employees who are injured on the job or who have developed work-related disorders,disabilities,or illnesses

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 the Part of Medicare to its definition.Note: Answers may be used more than once.
-​Provide coverage for both generic and brand-name drugs

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 5

Because a primary care physician (PCP)in an HMO makes referrals and approves additional care if needed,he or she is known as the:

Accepted Answer

A)  gatekeeper 
B)  patient advocate 
C)  specialist 
D)  care manager 
A)  gatekeeper 
B)  patient advocate 
C)  specialist 
D)  care manager

Question 6

​Match the Part of Medicare to its definition.Note: Answers may be used more than once.
-​A benefit that was introduced for beneficiaries as of January 1,2005,was the Initial Preventive Physical Exam,otherwise known as the Welcome to Medicare visit

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 7

Physicians who treat patients under workers' compensation plans are usually required to register with the state Workers' Compensation Board:

Accepted Answer

A)  anytime they need to file a claim 
B)  only once,unless they move or change the name of the medical practice 
C)  on an annual basis 
D)  every 5 years 
A)  anytime they need to file a claim 
B)  only once,unless they move or change the name of the medical practice 
C)  on an annual basis 
D)  every 5 years

Question 8

​Match the Part of Medicare to its definition.Note: Answers may be used more than once.
-Enables beneficiaries to select a managed care plan as their primary coverage

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 9

​Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once.
-​Any amount not used in a given year remains in the account and continues to gain interest

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 10

Match each health insurance term with its definition.
-Procedures used by insurers to avoid duplication of payment on claims when the patient has more than one policy

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 11

​Match the following terms with its definition.
-​Seeking approval for a treatment (surgery,hospitalization,diagnostic test)under the patient's insurance contract

Accepted Answer

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

Question 12

​Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once.
-An employer can contribute,but an employee cannot

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 13

​Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once.
-​A "use it or lose it" type 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 14

Match each health insurance term with its definition.
-Condition that existed before the insured's policy was issued

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 15

​Another variable with primary and secondary coverage occurs when a person qualifies for Medicare by virtue of age but remains employed.If the employee continues to work and is employed by a company with 20 or more employees,the group plan:

Accepted Answer

A)  ​is the sole payer 
B)  ​does not have to pay 
C)  ​the group plan is billed as primary and Medicare is billed as secondary 
D)  ​Medicare is billed as primary and the group plan is billed as secondary 
A)  ​is the sole payer 
B)  ​does not have to pay 
C)  ​the group plan is billed as primary and Medicare is billed as secondary 
D)  ​Medicare is billed as primary and the group plan is billed as secondary

Question 16

Match each health insurance term with its definition.
-Group insurance that entitles members to services provided by participating hospitals,clinics,and providers

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 17

Part ___ of Medicare was created to provide coverage for both generic and brand name drugs.

Accepted Answer

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

Question 18

​What is the requirement to generate a referral for a patient with a managed care insurance plan?

Accepted Answer

A)  ​Patient must first see his or her primary care provider (PCP). 
B)  ​The PCP must generate a referral in order for the patient to see a specialist. 
C)  ​The provider (or M
A) must obtain verification of eligibility for services. 
D)  ​All of the above. 
A)  ​Patient must first see his or her primary care provider (PCP). 
B)  ​The PCP must generate a referral in order for the patient to see a specialist. 
C)  ​The provider (or M
A) must obtain verification of eligibility for services. 
D)  ​All of the above.

Question 19

Match each health insurance term with its definition.
-Method of controlling health care costs by reviewing services to be provided to members of a plan to determine the appropriateness and medical necessity of the care prior to the delivery of the care

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 20

​Which of the following are considered third-party (insurance)plans?

Accepted Answer

A)  ​Group health plans 
B)  ​Medicare 
C)  ​Court-ordered health coverage 
D)  ​All of the above 
A)  ​Group health plans 
B)  ​Medicare 
C)  ​Court-ordered health coverage 
D)  ​All of the above

Exam 27: Health Insurance

Match each health insurance term with its definition. -List of predetermined payment amounts for professional services provided to patients

​Which type of insurance does not require a referral for patient care and specialists?

Match each health insurance term with its definition. -A form of insurance providing wage replacement and medical benefits to employees who are injured on the job or who have developed work-related disorders,disabilities,or illnesses

​Match the Part of Medicare to its definition.Note: Answers may be used more than once. -​Provide coverage for both generic and brand-name drugs

Because a primary care physician (PCP)in an HMO makes referrals and approves additional care if needed,he or she is known as the:

​Match the Part of Medicare to its definition.Note: Answers may be used more than once. -​A benefit that was introduced for beneficiaries as of January 1,2005,was the Initial Preventive Physical Exam,otherwise known as the Welcome to Medicare visit

Physicians who treat patients under workers' compensation plans are usually required to register with the state Workers' Compensation Board:

​Match the Part of Medicare to its definition.Note: Answers may be used more than once. -Enables beneficiaries to select a managed care plan as their primary coverage

​Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once. -​Any amount not used in a given year remains in the account and continues to gain interest

Match each health insurance term with its definition. -Procedures used by insurers to avoid duplication of payment on claims when the patient has more than one policy

​Match the following terms with its definition. -​Seeking approval for a treatment (surgery,hospitalization,diagnostic test)under the patient's insurance contract

​Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once. -An employer can contribute,but an employee cannot

​Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once. -​A "use it or lose it" type plan

Match each health insurance term with its definition. -Condition that existed before the insured's policy was issued

​Another variable with primary and secondary coverage occurs when a person qualifies for Medicare by virtue of age but remains employed.If the employee continues to work and is employed by a company with 20 or more employees,the group plan:

Match each health insurance term with its definition. -Group insurance that entitles members to services provided by participating hospitals,clinics,and providers

Part ___ of Medicare was created to provide coverage for both generic and brand name drugs.

​What is the requirement to generate a referral for a patient with a managed care insurance plan?

Match each health insurance term with its definition. -Method of controlling health care costs by reviewing services to be provided to members of a plan to determine the appropriateness and medical necessity of the care prior to the delivery of the care

​Which of the following are considered third-party (insurance)plans?

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 type of insurance does not require a referral for patient care and specialists?

Match the Part of Medicare to its definition.Note: Answers may be used more than once. -Provide coverage for both generic and brand-name drugs

Match the Part of Medicare to its definition.Note: Answers may be used more than once. -A benefit that was introduced for beneficiaries as of January 1,2005,was the Initial Preventive Physical Exam,otherwise known as the Welcome to Medicare visit

Match the Part of Medicare to its definition.Note: Answers may be used more than once. -Enables beneficiaries to select a managed care plan as their primary coverage

Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once. -Any amount not used in a given year remains in the account and continues to gain interest

Match the following terms with its definition. -Seeking approval for a treatment (surgery,hospitalization,diagnostic test)under the patient's insurance contract

Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once. -An employer can contribute,but an employee cannot

Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once. -A "use it or lose it" type plan

Another variable with primary and secondary coverage occurs when a person qualifies for Medicare by virtue of age but remains employed.If the employee continues to work and is employed by a company with 20 or more employees,the group plan:

What is the requirement to generate a referral for a patient with a managed care insurance plan?

Which of the following are considered third-party (insurance)plans?