Question 1

Match between columns
                        Premises: State-administered program to help pay costs of health care for low-income and disabled individuals.

Accepted Answer

The Answer of Accounts payable and Coding and Priority and is...

Question 2

Which of the following allows members to choose to receive a service from a participating or nonparticipating provider?

Accepted Answer

A)  point-of-service plan (POS) 
B)  preferred provider organization (PPO) 
C)  exclusive provider organization (EPO) 
D)  health maintenance organization (HMO) 
A)  point-of-service plan (POS) 
B)  preferred provider organization (PPO) 
C)  exclusive provider organization (EPO) 
D)  health maintenance organization (HMO) A

Question 3

Which of the following is true about prepaid plans?

Accepted Answer

A)  Fees are negotiated at time of service. 
B)  Providers are paid before rather than after services are performed. 
C)  Preauthorization is required. 
D)  Providers are paid after rather than before services are performed. 
A)  Fees are negotiated at time of service. 
B)  Providers are paid before rather than after services are performed. 
C)  Preauthorization is required. 
D)  Providers are paid after rather than before services are performed. B

Question 4

The fee-for-service method of determining medical costs means that:

Accepted Answer

A)  insurance companies pay a fixed amount for medical services. 
B)  physicians set their own prices for services. 
C)  the government helps pay for services. 
D)  patients must pay a certain percentage of the fee. 
A)  insurance companies pay a fixed amount for medical services. 
B)  physicians set their own prices for services. 
C)  the government helps pay for services. 
D)  patients must pay a certain percentage of the fee.

Question 5

Health care costs are evenly distributed among all patients.

Accepted Answer

A) True 
 B)False

Question 6

Health care specialists are also referred to as gatekeepers.

Accepted Answer

A) True 
 B)False

Question 7

Match between columns
                        Premises: A cost-sharing provision that stipulates that the insured is to assume a percentage of the costs of covered services.

Accepted Answer

The Answer of Accounts payable and Co-pay and Premium and is...

Question 8

Acting with _____ means considering facts and the best course of action in a given situation.

Accepted Answer

The answer of Acting with _____ means considering facts and...

Question 9

Which statement is true about the Veterans Health Administration (VA)?

Accepted Answer

A)  It is administered by the individual states. 
B)  It provides health care for all veterans. 
C)  It is the largest integrated health care systems in the United States. 
D)  It provides health care for active duty military. 
A)  It is administered by the individual states. 
B)  It provides health care for all veterans. 
C)  It is the largest integrated health care systems in the United States. 
D)  It provides health care for active duty military.

Question 10

_____ is a public health insurance program for low-income and low-asset individuals and families.

Accepted Answer

The answer of _____ is a public health insurance program...

Question 11

Which of the following is true about the Affordable Care Act of 2010?

Accepted Answer

A)  It provides free health care to every American. 
B)  It is a part of the Medicare system for older Americans. 
C)  Its major purpose is to make health insurance more accessible. 
D)  Its major goal is to help Americans make healthy lifestyle choices. 
A)  It provides free health care to every American. 
B)  It is a part of the Medicare system for older Americans. 
C)  Its major purpose is to make health insurance more accessible. 
D)  Its major goal is to help Americans make healthy lifestyle choices.

Question 12

What is the MOST serious consequence for a facility if treatments administered to patients are frequently reported and coded incorrectly?

Accepted Answer

A)  Accusations of fraud 
B)  Lower profits than expected 
C)  Failure to obtain reimbursement from insurance companies 
D)  Low staff efficiency 
A)  Accusations of fraud 
B)  Lower profits than expected 
C)  Failure to obtain reimbursement from insurance companies 
D)  Low staff efficiency

Question 13

Match between columns
                        Premises: Amount that patients who are covered by insurance must pay themselves for health care services.

Accepted Answer

The Answer of Deductible and Premium and Medicaid and Coinsurance is...

Question 14

In the United States, the increasing incidence of _____, a disease characterized by insulin resistance, costs several billion dollars a year to treat.

Accepted Answer

The answer of In the United States, the increasing incidence...

Question 15

Match between columns
                        Premises: Money that a business owes for supplies or services received.

Accepted Answer

The Answer of Coding and Priority and Medicaid and Accounts is...

Question 16

If an insurance plan is based on negotiated fees with health care providers, this means that the providers:

Accepted Answer

A)  agree in advance to accept set fees for specific services. 
B)  will not refer patients to specialists without preauthorization. 
C)  cannot charge patients a co-pay. 
D)  get authorization from the insurance company before giving treatment. 
A)  agree in advance to accept set fees for specific services. 
B)  will not refer patients to specialists without preauthorization. 
C)  cannot charge patients a co-pay. 
D)  get authorization from the insurance company before giving treatment.

Question 17

What is meant by "spreading the risk" among enrollees in a health insurance plan?

Accepted Answer

A)  Physicians may only charge predetermined amounts for services. 
B)  Only groups who work for large companies are covered. 
C)  Some enrollees never use the services. 
D)  Only certain services are paid for. 
A)  Physicians may only charge predetermined amounts for services. 
B)  Only groups who work for large companies are covered. 
C)  Some enrollees never use the services. 
D)  Only certain services are paid for.

Question 18

How do physicians who are PCPs contribute to the control of health care costs?

Accepted Answer

A)  Eliminate the need for expensive specialists 
B)  Evaluate and coordinate the health care needs of patients 
C)  Provide all services in one facility 
D)  Agree to charge only predetermined amounts 
A)  Eliminate the need for expensive specialists 
B)  Evaluate and coordinate the health care needs of patients 
C)  Provide all services in one facility 
D)  Agree to charge only predetermined amounts

Question 19

A major concern in the United States today is how to effectively control dramatically rising health care costs.

Accepted Answer

A) True 
 B)False

Question 20

Many Americans prefer treatment with prescription _____ rather than making lifestyle changes to improve their health.

Accepted Answer

The answer of Many Americans prefer treatment with prescription _____...

Exam 22: Paying for Health Care

Which of the following allows members to choose to receive a service from a participating or nonparticipating provider?

Which of the following is true about prepaid plans?

The fee-for-service method of determining medical costs means that:

Health care costs are evenly distributed among all patients.

Health care specialists are also referred to as gatekeepers.

Acting with _____ means considering facts and the best course of action in a given situation.

Which statement is true about the Veterans Health Administration (VA)?

_____ is a public health insurance program for low-income and low-asset individuals and families.

Which of the following is true about the Affordable Care Act of 2010?

What is the MOST serious consequence for a facility if treatments administered to patients are frequently reported and coded incorrectly?

In the United States, the increasing incidence of _____, a disease characterized by insulin resistance, costs several billion dollars a year to treat.

If an insurance plan is based on negotiated fees with health care providers, this means that the providers:

What is meant by "spreading the risk" among enrollees in a health insurance plan?

How do physicians who are PCPs contribute to the control of health care costs?

A major concern in the United States today is how to effectively control dramatically rising health care costs.

Many Americans prefer treatment with prescription _____ rather than making lifestyle changes to improve their health.

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