Health Insurance Questions Quiz! Exam

98 Questions | Total Attempts: 162

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Health Insurance Questions Quiz! Exam

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Questions and Answers
  • 1. 
    A predetermined amount that the time insured must pay each year before the insurance company will pay for an accident or illness.
    • A. 

      Fee disclosure

    • B. 

      Fee slip

    • C. 

      Fee schedule

    • D. 

      Deductible

  • 2. 
    A list of approved professional services for which the insurance company will pay with the maximum fee paid for each service. 
    • A. 

      Deductible

    • B. 

      Fee slip

    • C. 

      Fee schedule

    • D. 

      Fee disclosure

  • 3. 
    A prepaid group practice serving geographic areas with a wide range of comprehensive health care at a fixed fee schedule. 
    • A. 

      Fee slip

    • B. 

      Managed care

    • C. 

      Gatekeeper

    • D. 

      HMO

  • 4. 
    Procedures used by insurers to avoid duplication of payment on claims when the patient has more than one policy.
    • A. 

      Coordination of benefits

    • B. 

      Fee slip

    • C. 

      Deductible

    • D. 

      Coordination of patient care

  • 5. 
    A printed description of the benefits provided by the insurer to the beneficiary. 
    • A. 

      Explanation of benefits

    • B. 

      Coordination of benefits

    • C. 

      Copayment

    • D. 

      Assignment of benefits

  • 6. 
    A government program that provides insurance coverage for those who are injured on the job or who have developed work-related disorders, disabilities, or illnesses.
    • A. 

      Managed care

    • B. 

      Indemnity plan

    • C. 

      Workers compensation

    • D. 

      Medicaid

  • 7. 
    Prior authorization must be obtained before the patient is admitted to the hospital or some specified outpatient or in-office procedure. 
    • A. 

      Preauthorization

    • B. 

      Precertification

    • C. 

      Preexisting condition

    • D. 

      Predetermination

  • 8. 
    A joint funding program by federal and state governments for low-income patients for their medical care. 
    • A. 

      Medicare

    • B. 

      Medicaid

    • C. 

      Medifill

    • D. 

      Medigap

  • 9. 
    A term is given to a primary care physician for coordinating the patient's care to a specialist, hospital admissions, and so on. 
    • A. 

      Network physicians

    • B. 

      Workers compensation

    • C. 

      Gatekeeper

    • D. 

      Patient

  • 10. 
    Established to aid dependents of active service personnel, retired service personnel and their dependents, and dependents who died on active duty, with a supplement for medical care in military or public health service facilities. 
    • A. 

      HCPCS

    • B. 

      Tricare

    • C. 

      Service area

    • D. 

      CHAMPVA

  • 11. 
    Monies paid for an insurance contract.
    • A. 

      Copayment

    • B. 

      Premium

    • C. 

      Deductible

    • D. 

      Conisurance

  • 12. 
    A specified amount that the insured must pay toward the charge for professional services rendered. 
    • A. 

      Copayment

    • B. 

      Deductible

    • C. 

      Coinsurance

    • D. 

      Premium

  • 13. 
    A condition that existed before the insured's policy was issued.
    • A. 

      Precertification

    • B. 

      Preauthorization

    • C. 

      Preexisting

    • D. 

      Predetermination

  • 14. 
    The standard claim form of the centers for Medicare and Medicaid Services to submit physician services for third-party payment.
    • A. 

      CMS-1500

    • B. 

      PPO

    • C. 

      PCP

    • D. 

      HMO

  • 15. 
    The physician who admits a patient to the hospital.
    • A. 

      Diagnosis related group

    • B. 

      Attending physician

    • C. 

      Admitting physician

    • D. 

      Primary care physician

  • 16. 
    Coding system published by the AMA that translates services received by a patient into a numeric value for convenience and continuity of reporting these services to third parties for payment.
    • A. 

      CMS-1500

    • B. 

      HMO

    • C. 

      CPT

    • D. 

      HCPCS

  • 17. 
    The person who has been insured; an insurance policyholder.
    • A. 

      Subscriber

    • B. 

      Independent practice association

    • C. 

      Gatekeeper

    • D. 

      Individual insurance

  • 18. 
    A system developed by Yale Univ to group together major diagnostic categories, and organized by body systems.
    • A. 

      HMO's

    • B. 

      Diagnosis related groups

    • C. 

      Managed care

    • D. 

      Indemnity plan

  • 19. 
    HCPCS Level II "J" codes depict 
    • A. 

      Injectables

    • B. 

      Orthotics

    • C. 

      DMEs

    • D. 

      Lab supplies

  • 20. 
    Which type of HMO is composed of individual health care providers joined together to provide prepaid health care to groups and individuals? 
    • A. 

      Staff model

    • B. 

      Independent practice association

    • C. 

      Group model

    • D. 

      Open-ended

  • 21. 
    Traditional indemnity insurance coverage is ogern referred to as a ___ plan. 
    • A. 

      80/20

    • B. 

      60/40

    • C. 

      90/10

    • D. 

      50/50

  • 22. 
    In what year did Medicare begin providing coverage for one routine physical exam per year? 
    • A. 

      2003

    • B. 

      2005

    • C. 

      1995

    • D. 

      2000

  • 23. 
    In a  managed care delivery system, who is responsible for coordinating all care for the patient? 
    • A. 

      The patient

    • B. 

      The gatekeeper

    • C. 

      Workers compensation

    • D. 

      Network physicians

  • 24. 
    Which of the following coding rules is accurate? 
    • A. 

      Code each problem to the lowest level of specificity available in the classification

    • B. 

      Code the maximum number of diagnoses that fully describe the patient's care received on that visit

    • C. 

      Code correctly and completely any diagnosis or procedure that affects the care, influences the health status, or is a reason for treatment on that visit

    • D. 

      All of the above

  • 25. 
    A Medicare patient's health insurance claim number is comprised of which one of the following:
    • A. 

      Alpha character, date of birth, alpha character

    • B. 

      Social security number, alpha character

    • C. 

      Randomly assigned numbers and alpha character

    • D. 

      Alpha characters only

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