Question 1

​The standard claim form designed by the Centers for Medicare and Medicaid Services to submit provider services for third-party (insurance companies)payment is known as:

Accepted Answer

A)  ​the Affordable Care Act 
B)  ​the CMS-1500 
C)  ​the coordination of benefits 
D)  ​the fee disclosure

Question 2

Match each health insurance term with its definition.
-Required by Medicare when a service is provided to a beneficiary who is either not covered or the provider is unsure of coverage

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

Question 3

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

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)

Question 4

​Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once.
-​A tax-sheltered savings account that can be used to pay for medical expenses

Accepted Answer

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

Question 5

Ideally,a person in the medical office is designated the ____ and is expected to submit accurate claims in compliance with the many rules and regulations.

Accepted Answer

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

Question 6

Which type of HMO is composed of providers who practice in their own individual offices and retain their own staff and operations?

Accepted Answer

A)  staff model 
B)  group model 
C)  PPO 
D)  independent practice association

Question 7

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

Question 8

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

Question 9

Match each health insurance term with its definition.
-Health care delivery system that combines the delivery of health care and payment of the 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

Question 10

​Match the Part of Medicare to its definition.Note: Answers may be used more than once.
-​For hospital coverage

Accepted Answer

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

Question 11

Blue Cross was originally set up to pay for:

Accepted Answer

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

Question 12

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

Question 13

​Match the Part of Medicare to its definition.Note: Answers may be used more than once.
-​For payment of other medical expenses,including office visits,X-ray and laboratory services,and the services of a provider in or out of the hospital

Accepted Answer

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

Question 14

Health insurance offered by private companies to persons eligible for Medicare benefits and specifically designed to supplement such benefits is called:

Accepted Answer

A)  Medigap 
B)  Medicaid 
C)  TRICARE 
D)  CHAMPVA

Question 15

​Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once.
-​The employer owns the money in this account,and it might not be portable when the employee leaves the company

Accepted Answer

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

Question 16

Under workers' compensation,a patient who has an industrial injury is billed:

Accepted Answer

A)  for 20 percent of the cost of treatment 
B)  for 80 percent of the cost of treatment 
C)  for the entire cost of treatment 
D)  if treatment was given without authorization

Question 17

​Which of the following would be considered a step or steps to obtain precertification or preauthorization (predetermination)for a procedure for a patient with a managed care plan?

Accepted Answer

A)  ​Determine if precertification or preauthorization is required. 
B)  Locate the form on the insurance company website (or call the insurance company if you cannot locate or have questions). 
C)  ​Complete the form correctly,fax to the insurance company (or send electronic authorization request). 
D)  ​All of the above are necessary steps.

Question 18

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

Question 19

​Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once.
-​Preventive care is not subject to the deductible

Accepted Answer

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

Question 20

Match each health insurance term with its definition.
-Insurance offered to all employees by the employer

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)

Exam 27: Health Insurance

The standard claim form designed by the Centers for Medicare and Medicaid Services to submit provider services for third-party (insurance companies) payment is known as:

Match each health insurance term with its definition. -Required by Medicare when a service is provided to a beneficiary who is either not covered or the provider is unsure of coverage

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

Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once. -A tax-sheltered savings account that can be used to pay for medical expenses

Ideally,a person in the medical office is designated the ____ and is expected to submit accurate claims in compliance with the many rules and regulations.

Which type of HMO is composed of providers who practice in their own individual offices and retain their own staff and operations?

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

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. -Health care delivery system that combines the delivery of health care and payment of the services

Match the Part of Medicare to its definition.Note: Answers may be used more than once. -For hospital coverage

Blue Cross was originally set up to pay for:

Match the Part of Medicare to its definition.Note: Answers may be used more than once. -For payment of other medical expenses,including office visits,X-ray and laboratory services,and the services of a provider in or out of the hospital

Health insurance offered by private companies to persons eligible for Medicare benefits and specifically designed to supplement such benefits is called:

Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once. -The employer owns the money in this account,and it might not be portable when the employee leaves the company

Under workers' compensation,a patient who has an industrial injury is billed:

Which of the following would be considered a step or steps to obtain precertification or preauthorization (predetermination) for a procedure for a patient with a managed care plan?

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 the type of consumer-driven health plan to its definition.Note: Answers can be used more than once. -Preventive care is not subject to the deductible

Match each health insurance term with its definition. -Insurance offered to all employees by the employer

Exam 27: Health Insurance

​The standard claim form designed by the Centers for Medicare and Medicaid Services to submit provider services for third-party (insurance companies) payment is known as:

Match each health insurance term with its definition. -Required by Medicare when a service is provided to a beneficiary who is either not covered or the provider is unsure of coverage

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

​Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once. -​A tax-sheltered savings account that can be used to pay for medical expenses

Ideally,a person in the medical office is designated the ____ and is expected to submit accurate claims in compliance with the many rules and regulations.

Which type of HMO is composed of providers who practice in their own individual offices and retain their own staff and operations?

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

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. -Health care delivery system that combines the delivery of health care and payment of the services

​Match the Part of Medicare to its definition.Note: Answers may be used more than once. -​For hospital coverage

Blue Cross was originally set up to pay for:

​Match the Part of Medicare to its definition.Note: Answers may be used more than once. -​For payment of other medical expenses,including office visits,X-ray and laboratory services,and the services of a provider in or out of the hospital

Health insurance offered by private companies to persons eligible for Medicare benefits and specifically designed to supplement such benefits is called:

​Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once. -​The employer owns the money in this account,and it might not be portable when the employee leaves the company

Under workers' compensation,a patient who has an industrial injury is billed:

​Which of the following would be considered a step or steps to obtain precertification or preauthorization (predetermination) for a procedure for a patient with a managed care plan?

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 the type of consumer-driven health plan to its definition.Note: Answers can be used more than once. -​Preventive care is not subject to the deductible

Match each health insurance term with its definition. -Insurance offered to all employees by the employer

The standard claim form designed by the Centers for Medicare and Medicaid Services to submit provider services for third-party (insurance companies) payment is known as:

Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once. -A tax-sheltered savings account that can be used to pay for medical expenses

Match the Part of Medicare to its definition.Note: Answers may be used more than once. -For hospital coverage

Match the Part of Medicare to its definition.Note: Answers may be used more than once. -For payment of other medical expenses,including office visits,X-ray and laboratory services,and the services of a provider in or out of the hospital

Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once. -The employer owns the money in this account,and it might not be portable when the employee leaves the company

Which of the following would be considered a step or steps to obtain precertification or preauthorization (predetermination) for a procedure for a patient with a managed care plan?

Match the type of consumer-driven health plan to its definition.Note: Answers can be used more than once. -Preventive care is not subject to the deductible