Question 1

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 managerE) B) and D)
F) None of the above

Question 2

Blue Cross was originally set up to pay for:

Accepted Answer

A)   physicians' services
B)   hospital expenses
C)   prescription medications
D)   preventive health careE) B) and C)
F) All of the above

Question 3

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 areaF) subscriberG) individual insuranceH) indemnity planI) utilization management (review) J) workers' compensationK) E) and J)
L) D) and I)

Question 4

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)   TRICAREE) None of the above
F) A) and B)

Question 5

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)  copaymentF) deductibleG) effective dateH) capitationI) group insuranceJ) health maintenance organization (HMO) K) A) and E)
L) F) and I)

Question 6

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)  copaymentF) deductibleG) effective dateH) capitationI) group insuranceJ) health maintenance organization (HMO) K) D) and F)
L) D) and J)

Question 7

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

Accepted Answer

A)   20
B)   60
C)   70
D)   80E) A) and C)
F) A) and D)

Question 8

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 areaF) subscriberG) individual insuranceH) indemnity planI) utilization management (review) J) workers' compensationK) C) and H)
L) D) and H)

Question 9

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 scheduleF) loss-of-income benefitsG) participating providerH) patient statusI) Relative Value UnitsJ) third-party payerK) D) and H)
L) B) and E)

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)  copaymentF) deductibleG) effective dateH) capitationI) group insuranceJ) health maintenance organization (HMO) K) G) and I)
L) A) and G)

Question 11

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 planningE) C) and D)
F) None of the above

Question 12

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 areaF) subscriberG) individual insuranceH) indemnity planI) utilization management (review) J) workers' compensationK) D) and E)
L) C) and H)

Question 13

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 areaF) subscriberG) individual insuranceH) indemnity planI) utilization management (review) J) workers' compensationK) F) and I)
L) B) and I)

Question 14

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)  copaymentF) deductibleG) effective dateH) capitationI) group insuranceJ) health maintenance organization (HMO) K) I) and J)
L) B) and E)

Question 15

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 specialistE) A) and D)
F) A) and C)

Question 16

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 scheduleF) loss-of-income benefitsG) participating providerH) patient statusI) Relative Value UnitsJ) third-party payerK) E) and H)
L) B) and H)

Question 17

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 scheduleF) loss-of-income benefitsG) participating providerH) patient statusI) Relative Value UnitsJ) third-party payerK) C) and H)
L) D) and E)

Question 18

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)  copaymentF) deductibleG) effective dateH) capitationI) group insuranceJ) health maintenance organization (HMO) K) A) and D)
L) B) and H)

Question 19

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 scheduleF) loss-of-income benefitsG) participating providerH) patient statusI) Relative Value UnitsJ) third-party payerK) B) and C)
L) B) and J)

Question 20

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

Accepted Answer

A)   monthly
B)   annual
C)   biannual
D)   as-neededE) C) and D)
F) B) and D)

Exam 14: The Muscular System

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

Correct Answer
verified

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

Correct Answer
verified

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

Correct Answer
verified

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

Correct Answer
verified

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

Correct Answer
verified

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

Correct Answer
verified

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

Correct Answer
verified

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

Correct Answer
verified

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

Correct Answer
verified

Correct Answer
verified

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

Correct Answer
verified

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

Correct Answer
verified

Blue Cross was originally set up to pay for:

Correct Answer
verified

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

Correct Answer
verified

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

Correct Answer
verified

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

Correct Answer
verified

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

Correct Answer
verified

Match each health insurance term with its definition. -Insurance purchased by an individual or family who does not have access to group health insurance

Correct Answer
verified

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

Correct Answer
verified

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

Correct Answer
verified

Exam 14: The Muscular System

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

Blue Cross was originally set up to pay for:

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

Match each health insurance term with its definition. -Insurance purchased by an individual or family who does not have access to group health insurance

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

Correct Answer
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Correct Answer
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