MA Intro Week 3 Theory Exam Review Quiz

COBRA stands for Consolidated Omnibus Budget Reconciliation Act. It is a federal act that provides workers who lose their insurance benefits the option to continue their group coverage temporarily. This allows individuals to maintain their health insurance coverage even after experiencing job loss, reduction in work hours, or other qualifying events. COBRA ensures that individuals and their families have access to healthcare during times of transition or hardship.

The answer UCR stands for Usual, Customary, and Reasonable. It refers to a fee structure that is determined by considering what most physicians charge for a similar procedure in the same geographic area. This helps to establish a benchmark for the cost of the procedure and ensures that the fees charged are within a reasonable range.

Health insurance is a type of coverage that helps individuals pay for medical expenses and provides financial protection in case of unexpected illnesses or injuries. By narrowing down undesirable events to illnesses and injuries, health insurance ensures that individuals are protected from the financial burden that may arise from such situations. It helps cover the cost of medical treatments, hospital stays, prescription medications, and other healthcare services, thereby providing individuals with access to necessary healthcare without incurring excessive out-of-pocket expenses. Therefore, the statement "Health insurance narrows down undesirable events to illnesses and injuries" is true.

A fee-for-service insurance plan is considered the "traditional" type of insurance plan because it allows policyholders to choose their healthcare providers and services. Under this plan, the insurance company pays for the services rendered by the healthcare provider, and the policyholder is responsible for paying a certain percentage of the cost, known as a co-payment or deductible. This type of plan offers more flexibility and choice for individuals in selecting their healthcare providers and treatments compared to other types of insurance plans such as managed care or HMOs.

A physician who contracts with a third-party payer and agrees to abide by certain rules set down by the payer is referred to as a PAR provider. This means that the physician has entered into a contractual agreement with the third-party payer, agreeing to accept the payer's approved fees as payment in full for services rendered to patients covered by that payer. This arrangement helps to ensure that the physician follows the guidelines and regulations set by the payer and provides appropriate care to patients within the payer's network.

A periodic fee paid for health insurance is commonly called a premium. This is the amount of money that an individual or group pays to an insurance company in exchange for coverage. The premium is typically paid monthly, quarterly, or annually and is based on factors such as age, health status, and the level of coverage desired. The insurance company uses these premiums to cover the costs of medical expenses and other healthcare services for the insured individuals.

Medicaid is the combined federal and state health care program for indigent and low-income individuals. It provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. Medicaid is funded jointly by the federal government and individual states, and it helps to cover various medical services such as doctor visits, hospital stays, long-term care, and more. Blue Cross is an insurance company, health maintenance refers to a type of healthcare delivery system, and Medicare is a federal health insurance program for people aged 65 and older or with certain disabilities.

Workers' compensation is a type of insurance that provides financial coverage to employees who become ill or injured while performing their job duties. This insurance pays for medical expenses, rehabilitation costs, and a portion of lost wages during the recovery period. It is designed to protect both the employee and the employer by ensuring that injured workers receive proper medical care and compensation, while also protecting employers from potential lawsuits related to workplace injuries.

Medicare is the federal health care program for the elderly and certain qualifying individuals. It provides health insurance coverage for individuals aged 65 and older, as well as younger individuals with certain disabilities or end-stage renal disease. Medicare helps cover the cost of various medical services, including hospital stays, doctor visits, prescription drugs, and preventive care. It is different from Medicaid, which is a joint federal and state program that provides health coverage to low-income individuals and families. Blue Cross and health maintenance are not specific federal health care programs for the elderly and qualifying individuals.

A participating provider is one who contracts with the insurer, agreeing to abide by certain rules and regulations of that carrier. This means that the provider has agreed to accept the insurer's payment as full reimbursement for services rendered and has agreed to follow the insurer's guidelines for billing and documentation. This arrangement allows the provider to be part of the insurer's network and ensures that the insurer will cover a portion of the cost of care for patients who choose to see that provider.

Fee-for-service health care plans are also referred to as indemnity insurance because they provide coverage for medical expenses by reimbursing the policyholder for the costs incurred. Under this type of plan, individuals have the freedom to choose their healthcare providers and services without restrictions or referrals. The insurance company pays a predetermined percentage of the covered expenses, while the policyholder is responsible for paying the remaining costs. This type of plan offers flexibility and allows individuals to have more control over their healthcare decisions.

Third-party payers, such as insurance companies, typically do not cover medical services that are not medically necessary. This means that the services are not required for the diagnosis, treatment, or prevention of a medical condition. Insurance companies aim to cover services that are essential for the patient's health and well-being. Therefore, if a medical service is deemed unnecessary by the payer, they will not provide coverage or reimbursement for it.

HIPAA stands for the Health Insurance Portability and Accountability Act. This congressional act was implemented to address various issues in healthcare, including preexisting conditions. It ensures that individuals with preexisting conditions cannot be denied health insurance coverage or charged higher premiums. HIPAA also protects the privacy and security of individuals' health information and establishes standards for electronic healthcare transactions. Therefore, HIPAA is the correct answer as it directly relates to the given question about a congressional act that addresses problems like preexisting conditions and other healthcare-related issues.

A deductible is the dollar amount that a patient must pay each year before his or her insurance benefits begin. This means that the patient is responsible for paying this amount out of pocket before the insurance coverage kicks in. Once the deductible is met, the insurance company will start covering a portion or all of the medical expenses as outlined in the policy.

Most health insurers require patients to pay a portion of the charge called coinsurance. Coinsurance refers to the percentage of the medical costs that the patient is responsible for paying after the deductible has been met. This is a common practice in health insurance plans where the insurer and the insured share the cost of healthcare services.

The CMS-1500 form is the most commonly used form for insurance claims today. It is used by healthcare providers to submit claims for reimbursement from insurance companies. The form includes information such as patient demographics, diagnosis codes, procedure codes, and the cost of services provided. It is standardized and accepted by most insurance companies, making it the preferred form for submitting claims.

Many employed individuals obtain health care coverage through a group plan because it is a common benefit provided by employers. Group plans typically offer more affordable premiums and broader coverage compared to individual policies. Additionally, group plans often have lower deductibles and out-of-pocket costs. They also provide a sense of security as they are backed by a larger pool of participants, reducing the risk for insurers. Government-sponsored programs and guaranteed insurance pools are options for those who are not covered by an employer-sponsored group plan.

A group contract is an insurance contract made with a business entity that provides coverage to its employees equally. This type of contract is designed to offer insurance benefits to a group of individuals, such as employees of a company, rather than providing individual policies. Group contracts are commonly used in the workplace to provide health insurance, life insurance, or other types of coverage to employees.

The correct answer is "enrollees". People who are covered under managed care plans are commonly referred to as enrollees because they have enrolled or signed up for the plan. This term is used to specifically identify individuals who are part of the managed care system and receive benefits and services through their enrollment in the plan.

Insurance companies often set a maximum limit on the amount that a patient has to pay for their healthcare expenses, which is known as the "out-of-pocket maximum." This means that once the patient reaches this maximum limit, the insurance company will cover all additional costs for the remainder of the coverage period. This helps protect patients from excessively high medical bills and ensures that their financial burden is limited.

Employed in government jobs typically have access to health insurance benefits provided by the government. Therefore, they are not typically without health insurance.

Insurance payments are typically based on UCR (Usual, Customary, and Reasonable) rates. These rates represent the average fees charged by healthcare providers in a specific geographic area. Insurance companies use UCR rates as a benchmark to determine the maximum amount they will reimburse for a particular medical service. These rates vary from state to state and are influenced by factors such as the cost of living and the local healthcare market. Therefore, UCR rates are a common and relevant factor in determining insurance payments.

Managed care is a relatively new concept of health care structure that emerged in the late 20th century. It refers to a system in which health care providers, such as doctors and hospitals, work together to coordinate and manage the care of patients. This approach aims to improve quality of care, control costs, and enhance patient outcomes by emphasizing preventive care, efficient resource utilization, and coordination among different providers. Managed care often involves health insurance plans that contract with specific networks of providers, offering a range of services and benefits to their members.

A medical savings account is a special tax shelter set up specifically for the purpose of paying medical bills. It allows individuals to save money on a tax-free basis, which can then be used to cover medical expenses. This type of account is typically paired with a high-deductible health insurance plan, where individuals are responsible for a certain amount of out-of-pocket expenses before the insurance coverage kicks in. By contributing to a medical savings account, individuals can set aside funds for future medical needs while also enjoying potential tax benefits.

The factors listed in the text that drive health care issues include regulating managed care plans, expanding access for uninsured Americans, and stabilizing emergency services. However, reducing health care costs is not listed as one of the factors.