Question 1

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 2

Match each health insurance term with its definition.
-When a health care provider is paid a fixed amount per member per month for each patient who is a member of a particular insurance organization, whether or not services were provided

Accepted Answer

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

Question 3

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

Question 4

Once a patient is ready to leave the hospital, ____ is used to ensure that the patient is being discharged to the most appropriate setting.

Accepted Answer

A)  discharge planning 
B)  capitation 
C)  utilization review 
D)  diagnostic planning 
A)  discharge planning 
B)  capitation 
C)  utilization review 
D)  diagnostic planning

Question 5

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 6

Blue Cross was originally set up to pay for:

Accepted Answer

A)  physicians' services 
B)  hospital expenses 
C)  prescription medications 
D)  preventive health care 
A)  physicians' services 
B)  hospital expenses 
C)  prescription medications 
D)  preventive health care

Question 7

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) copayment
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) copayment
F)deductible
G)effective date
H)capitation
I)group insurance
J)health maintenance organization (HMO)

Question 8

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 9

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 10

Match each health insurance term with its definition.
-Established for the spouses and dependent children of veterans who have total, permanent, service-connected disabilities

Accepted Answer

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

Question 11

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 12

Medicaid cards are issued to recipients on a(n) ____ basis.

Accepted Answer

A)  monthly 
B)  annual 
C)  biannual 
D)  as-needed 
A)  monthly 
B)  annual 
C)  biannual 
D)  as-needed

Question 13

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 14

Match each health insurance term with its definition.
-Established to aid dependents of active service personnel, retired service personnel and their dependents, and dependents of service personnel who died on active duty, with a supplement for medical care in military or Public Health Service facilities

Accepted Answer

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

Question 15

Match each health insurance term with its definition.
-Joint funding program by federal and state governments (excluding Arizona) 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 16

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 17

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 18

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

Accepted Answer

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

Question 19

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 20

Ideally, a person in each medical office is designated as the ____ and is expected to maintain currency with insurers and insurance regulations.

Accepted Answer

A)  medical coder 
B)  claims filer 
C)  update technician 
D)  seminar specialist 
A)  medical coder 
B)  claims filer 
C)  update technician 
D)  seminar specialist

Exam 14: The Muscular System

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

Match each health insurance term with its definition. -When a health care provider is paid a fixed amount per member per month for each patient who is a member of a particular insurance organization, whether or not services were provided

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

Once a patient is ready to leave the hospital, ____ is used to ensure that the patient is being discharged to the most appropriate setting.

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

Blue Cross was originally set up to pay for:

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

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

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. -Established for the spouses and dependent children of veterans who have total, permanent, service-connected disabilities

Match each health insurance term with its definition. -Numeric values assigned to payment components of the Resource-Based Relative Value Scale (RBRVS)

Medicaid cards are issued to recipients on a(n) ____ basis.

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

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

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

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

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

Ideally, a person in each medical office is designated as the ____ and is expected to maintain currency with insurers and insurance regulations.

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 Respiratory System

The Circulatory System

The Immune System

The Digestive System

The Urinary System

The Endocrine System

The Reproductive System

Telephone Communications

Written Communications

Operating Computers and Office Equipment

Scheduling Appointments and Receiving Patients

The Medical Record, Documentation, and Filing

Health Insurance

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

Maintaining the Office Environment

Filters