Question 1

Managed care has simplified the patient's responsibility for payment. True/False

Accepted Answer

True

Question 2

With managed care options, there is less emphasis on the medical assistant needing to be accurate and timely when filing insurance claims. True/False

Accepted Answer

False

Question 3

Preexisting conditions usually require a waiting period. True/False

Accepted Answer

True

Question 4

"Coordination of benefits" means that the insurance companies will take care of the paperwork. True/False

Accepted Answer

False

Question 5

Co-payment is the amount the insurance will cost the patient each month. True/False

Accepted Answer

False

Question 6

The _______ is a doctor chosen by the patient who is the first doctor the patient sees and is responsible for making referrals for further treatment by a specialist or for hospitalization.

Preauthorization
Primary Care Provider
Preferred Provider Organization
Referral

Accepted Answer

Primary Care Provider

Question 7

A ________ allows the enrollee to have the freedom to obtain medical care from an HMO provider or to self-refer to a non-HMO provider at a greater cost

Preauthorization
Proof of Eligibility
Point of Services Plan (POS)
PPO

Accepted Answer

Point of Services Plan (POS)

Question 8

The _________ was developed using values for each medical and surgical procedure based on work, practice, and malpractice costs and factoring in the regional differences.

Resource-based relative value system
Self insurance
Adjustment
Preauthorization

Accepted Answer

Resource-based relative value system

Question 9

_________ means that prior notice and approval needs to be obtained before services will be covered. Adjustment Referral Preauthorization Benefit period

Accepted Answer

Preauthorization

Question 10

A ________ is an organization of providers who network together to offer discounts to purchasers for health care insurance.

Resource-based relative value system
Usual customary and reasonable
Primary care provider
Preferred Provider Organization (PPO)

Accepted Answer

Preferred Provider Organization (PPO)

Question 11

The ________ is the specified time during which benefits will be paid under certain types of health insurance coverage. Benefit period Referral Self insurance Adjustment

Accepted Answer

Benefit period

Question 12

The amount a provider writes off the patient's account is known as an ________. Proof of eligibility Preauthorization Adjustment Benefit period

Accepted Answer

Adjustment

Question 13

________ is prescription drug coverage by Medicare. Part B Part C Part D Part A

Accepted Answer

Part D

Question 14

Covers outpatient expenses including providers' fees, lab tests, and radiologic studies. Part A Part B Part C Part D

Accepted Answer

Part B

Question 15

Covers hospital admission and stays. Part A Part B Part C Part D

Accepted Answer

Part A

Question 16

Advantage Insurance is Part ___. Part A Part B Part C Part D

Accepted Answer

Part C

Question 17

Does not require a monthly payment. Part A Part B Part C Part D

Accepted Answer

Part A

Question 18

Will start paying for services after a $147 deductible has been met. Part A Part B Part C Part D

Accepted Answer

Part B

Question 19

Covers hospice care. Part A Part B Part C Part D

Accepted Answer

Part A

Question 20

Match the words to the descriptions below. ``` Adjustment Capitation COB EOB Medigap policy ``` Plan to determine salary of the provider Individual plan covering the patient's medicare deductible and co-pay Provision of an insurance contract that limits benefits to 100% of the cost Increase or decrease to patient accounts Insurance report that is sent with claim payment

Accepted Answer

Adjustment Increase or decrease to patient accounts Capitation Plan to determine salary of the provider COB Provision of an insurance contract that limits benefits to 100% of the cost EOB Insurance report that is sent with claim payment Medigap policy Individual plan covering the patient's medicare deductible and co-pay

Final Study Flashcards

(50 cards)