Exam 2 Quizzes

Question 1

The largest employer-sponsered health program in the United States is

Answer 1

Federal Employees Health Benefits Program

Question 2

T or F? A carve out may be used by an employer to omit a specific plan benefit that is usually covered by a health plan

Answer 2

Correct Answer is True

Question 3

T or F? Elective surgery is not reimbursed because it is not medically necessary

Answer 3

Correct Answer is False

Question 4

T or F? Claims for private payers are sent first to patients who then send them to the employer.

Answer 4

Correct Answer is False

Question 5

T or F? If the participation contract states that copayments apply; the payer subtrats the patient’s copayment from the providers’s reimbursement

Answer 5

Correct Answer is True

Question 6

Undera a capitated HMO plan the physician practice receives

Answer 6

a monthly enrollment list

Question 7

T or F? A consumer driven plan involves a high-deductible health plan with a funding option such as a health savings account

Answer 7

Correct Answer is True

Question 8

What document is researched to uncover the rules for private payers’ definitions of insurance-related terms?

Answer 8

Participation contract

Question 9

The portability of health insurance is govered by which low

Answer 9

HIPAA and COBRA

Question 10

Providers who participate in a PPO are paid

Answer 10

a discounted fee for service

Question 11

Under the Medicare Part B traditional fee for service plan; medicare pays ?% of the allowed charges

Answer 11

eighty

Question 12

Medicaid identification cards must be checked for eligibility

Answer 12

every time the patient receives services

Question 13

T or F? Individuals who are employed are ineleigible for medicaid

Answer 13

Correct Answer is False

Question 14

T or F? Medicaid is know as the payer of last resort because an individula must exhaust all other resoures before medicaid pays for healthcare

Answer 14

Correct Answer is False

Question 15

Individuals apply for Medicaid by contacting

Answer 15

Department of Health and Human services or local Income Maintainence Office

Question 16

T or F? Medicare is the secodary payer for all beneficaries over age sixty five and working

Answer 16

Correct Answer is False

Question 17

Medicare part D covers

Answer 17

prescription drugs

Question 18

T or F? An ABN should be signed by the patient when the provider has reason to think that the services will not be covered by Medicare due to lack of medical necessity

Answer 18

Correct Answer is True

Question 19

Medicare Part A covers

Answer 19

hospital services

Question 20

T or F? A carve out may be used by an employer to omit a specific plan benefit that is usually covered by a health plan

Answer 20

Correct Answer is False

Question 21

T or ? Workers’ Compensation insurance does not cover injuries tin the company parking lot or cafeteria

Answer 21

Correct Answer is False

Question 22

An employee who believes the work environoment to be dangerous may file a complaint with the

Answer 22

Occupational Safety and Health Administration

Question 23

T or F? Individuals classified as permanently disabled receive compensation for lost wages and paid medical treatmenet for the work related illness or injury

Answer 23

Correct Answer is True

Question 24

? Provides workers’ compensation insurance coverage to employees of the federal government

Answer 24

Federal Employee’s Compensation Act

Question 25

T or F? A physician who treats a patient covered by workers’ compensation insurance may not charge the patient for any amount of the medical expense

Answer 25

Correct Answer is True

Question 26

? Is a denial of employee liability issued by the Workers’ Compensation insurance carrier

Answer 26

Notice of contest

Question 27

T or F? Occupational illness that develop over time are generally not covered by Workers’ compensation insurance

Answer 27

Correct Answer is False

Question 28

T or F? Most states require corporaitons that meet established financial standards to obtain authorization to become self insured against Workers’ Compentation claims

Answer 28

Correct Answer is True

Question 29

T or F? The Federal Employees’ Compensation Act (FECA) was created to protect workers from health and safety risks while on the job

Answer 29

Correct Answer is False

Question 30

Vocational rehab programs provide ? For individuals with job related disabilities

Answer 30

training in a different job