Question 1

Which type of HMO model consists of a provider group that contracts with one or more HMOs, but can also patients outside of the HMO?

Accepted Answer

A)   Staff model
B)   Independent practice association
C)   Group model
D)   None of the above

Question 2

A review of individual cases by a committee to make sure that services are medically necessary is called a(n)

Accepted Answer

A)   credentialing committee review.
B)   peer review committee evaluation.
C)   utilization review.
D)   audit committee review.

Question 3

Which of the following plans require healthcare providers to become participating providers?

Accepted Answer

A)   All government-sponsored health plans
B)   Most privately sponsored health plans
C)   Indemnity health insurance plans
D)   Both A and B
E)   All of the above

Question 4

There are no government managed care plans.

Accepted Answer

A) True 
 B)False

Question 5

Which part of Medicare covers inpatient hospital charges?

Accepted Answer

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

Question 6

A provider can choose whether to accept Medicaid patients.

Accepted Answer

A) True 
 B)False

Question 7

Health insurance designed for military dependents and retired military personnel is called

Accepted Answer

A)   CHAMPVA.
B)   TRICARE.
C)   Medicare.
D)   Medicaid. B

Question 8

Employer group policies usually provide greater benefits at lower premiums because of the large pool of people from whom premiums are collected. However, these employee-sponsored group health insurance plans offer limited benefits, and healthcare access is limited to healthcare providers that are contracted with them.

Accepted Answer

A)   Both statements are true.
B)   Both statements are false.
C)   The first statement is true; the second is false.
D)   The first statement is false; the second is true.

Question 9

A formal request for payment from an insurance company for services provided is

Accepted Answer

A)   explanation of benefits.
B)   fee schedule.
C)   claim.
D)   policy. C

Question 10

A designated person who receives funds from an insurance policy is

Accepted Answer

A)   beneficiary.
B)   claimant.
C)   gatekeeper.
D)   indigent.

Question 11

TRICARE is a form of government insurance for veterans of the U.S. armed forces.

Accepted Answer

A) True 
 B)False

Question 12

Which of the following MCOs typically has/have the lowest monthly premiums with lower patient financial responsibility?

Accepted Answer

A)   IPA
B)   PPOs
C)   HMOs
D)   None of the above

Question 13

Which of the following expenses would be paid by Medicare Part B?

Accepted Answer

A)   Inpatient hospital charges
B)   Hospice services
C)   Physician's office visits
D)   Home healthcare charges

Question 14

A policy that covers a number of people under a single contract issued to the employer

Accepted Answer

A)   group policy.
B)   individual policy.
C)   a government plan.
D)   a self-insured plan.

Question 15

A type of insurance that protects workers from loss of wages after an industrial accident that happened on the job is called

Accepted Answer

A)   an individual policy.
B)   workers' compensation.
C)   unemployment insurance.
D)   disability insurance.

Question 16

The medical assistant should always verify which of the following prior to the patient's appointment?

Accepted Answer

A)   Eligibility
B)   Benefits and exclusions
C)   Effective date of insurance
D)   All of the above

Question 17

The allowed amount for Medicare charges is determined using

Accepted Answer

A)   fee schedule.
B)   resource-based relative value scale.
C)   utilization management.
D)   provider network.

Question 18

Which part of Medicare covers prescription drug services?

Accepted Answer

A)   A
B)   B
C)   C
D)   D

Question 19

The physician who enters into a contract with an insurance company and agrees to certain rules and regulations is called a ______ provider.

Accepted Answer

A)   participating
B)   paying
C)   physician
D)   None of the above

Question 20

Veterans of the U.S. armed forces may be covered by

Accepted Answer

A)   CHAMPVA.
B)   TRICARE.
C)   workers' compensation.
D)   Blue Cross/Blue Shield.

Exam 23: Health Insurance Basics

Which type of HMO model consists of a provider group that contracts with one or more HMOs, but can also patients outside of the HMO?

Correct Answer
verified

A review of individual cases by a committee to make sure that services are medically necessary is called a(n)

Correct Answer
verified

Which of the following plans require healthcare providers to become participating providers?

Correct Answer
verified

There are no government managed care plans.

Correct Answer
verified

Which part of Medicare covers inpatient hospital charges?

Correct Answer
verified
A

A provider can choose whether to accept Medicaid patients.

Correct Answer
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Health insurance designed for military dependents and retired military personnel is called

Correct Answer
verified
B

Correct Answer
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A formal request for payment from an insurance company for services provided is

Correct Answer
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C

A designated person who receives funds from an insurance policy is

Correct Answer
verified

TRICARE is a form of government insurance for veterans of the U.S. armed forces.

Correct Answer
verified

Which of the following MCOs typically has/have the lowest monthly premiums with lower patient financial responsibility?

Correct Answer
verified

Which of the following expenses would be paid by Medicare Part B?

Correct Answer
verified

A policy that covers a number of people under a single contract issued to the employer

Correct Answer
verified

A type of insurance that protects workers from loss of wages after an industrial accident that happened on the job is called

Correct Answer
verified

The medical assistant should always verify which of the following prior to the patient's appointment?

Correct Answer
verified

The allowed amount for Medicare charges is determined using

Correct Answer
verified

Which part of Medicare covers prescription drug services?

Correct Answer
verified

The physician who enters into a contract with an insurance company and agrees to certain rules and regulations is called a ______ provider.

Correct Answer
verified

Veterans of the U.S. armed forces may be covered by

Correct Answer
verified

Exam 23: Health Insurance Basics

Which type of HMO model consists of a provider group that contracts with one or more HMOs, but can also patients outside of the HMO?

Correct AnswerverifiedShow Answer

A review of individual cases by a committee to make sure that services are medically necessary is called a(n)

Correct AnswerverifiedShow Answer

Which of the following plans require healthcare providers to become participating providers?

Correct AnswerverifiedShow Answer

There are no government managed care plans.

Correct AnswerverifiedShow Answer

Which part of Medicare covers inpatient hospital charges?

Correct AnswerverifiedA

A provider can choose whether to accept Medicaid patients.

Correct AnswerverifiedShow Answer

Health insurance designed for military dependents and retired military personnel is called

Correct AnswerverifiedB

Correct AnswerverifiedShow Answer

A formal request for payment from an insurance company for services provided is

Correct AnswerverifiedC

A designated person who receives funds from an insurance policy is

Correct AnswerverifiedShow Answer

TRICARE is a form of government insurance for veterans of the U.S. armed forces.

Correct AnswerverifiedShow Answer

Which of the following MCOs typically has/have the lowest monthly premiums with lower patient financial responsibility?

Correct AnswerverifiedShow Answer

Which of the following expenses would be paid by Medicare Part B?

Correct AnswerverifiedShow Answer

A policy that covers a number of people under a single contract issued to the employer

Correct AnswerverifiedShow Answer

A type of insurance that protects workers from loss of wages after an industrial accident that happened on the job is called

Correct AnswerverifiedShow Answer

The medical assistant should always verify which of the following prior to the patient's appointment?

Correct AnswerverifiedShow Answer

The allowed amount for Medicare charges is determined using

Correct AnswerverifiedShow Answer

Which part of Medicare covers prescription drug services?

Correct AnswerverifiedShow Answer

The physician who enters into a contract with an insurance company and agrees to certain rules and regulations is called a ______ provider.

Correct AnswerverifiedShow Answer

Veterans of the U.S. armed forces may be covered by

Correct AnswerverifiedShow Answer

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A

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B

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C

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