Question 1

A provider who is under no contractual agreement with the insurer to accept reimbursement as payment in full.

Accepted Answer

nonparticipating provider

Question 2

The form that is most commonly used today for insurance claims submitted on paper is the:

Accepted Answer

A)  UB-04. 
B)  CMS-1500. 
C)  HCFA-1490. 
D)  HCPCS 1090. 
A)  UB-04. 
B)  CMS-1500. 
C)  HCFA-1490. 
D)  HCPCS 1090. B

Question 3

Most health insurers ask that patients pay a portion (or percentage)of the charge for professional services.This charge is commonly referred to as:

Accepted Answer

A)  usual, customary, and reasonable (UCR). 
B)  coinsurance. 
C)  deductible. 
D)  reimbursement. 
A)  usual, customary, and reasonable (UCR). 
B)  coinsurance. 
C)  deductible. 
D)  reimbursement. B

Question 4

Illnesses or injury that occurred before the start of a health insurance contract.

Accepted Answer

preexistin

Question 5

Traditional healthcare in which patients can choose any provider they want (including specialists)and change physicians at any time.

Accepted Answer

indemnity (or fee-fo

Question 6

People who are covered under managed care plans are commonly referred to as:

Accepted Answer

A)  enrollees. 
B)  policyholders. 
C)  charter members. 
D)  covered entities. 
A)  enrollees. 
B)  policyholders. 
C)  charter members. 
D)  covered entities.

Question 7

Disability insurance is the same as workers' compensation.

Accepted Answer

A) True 
 B)False

Question 8

Flexible spending accounts are "cafeteria" plans,meaning premiums are deducted from the employee's wages before withholding taxes are deducted.

Accepted Answer

A) True 
 B)False

Question 9

Define the Consolidated Omnibus Budget Reconciliation Act (COBRA),who it applies to,and the provisions contained within this law.

Accepted Answer

COBRA generally applies to group healthc

Question 10

A _____ provider is one who contracts with the insurer,agreeing to abide by certain rules and regulations of that carrier.

Accepted Answer

A)  participating 
B)  nonparticipating 
C)  managed healthcare 
D)  fee-for-service 
A)  participating 
B)  nonparticipating 
C)  managed healthcare 
D)  fee-for-service

Question 11

When medical services,procedures,or supplies meet specific criteria and are proper and needed for the diagnosis or treatment of a patient's medical condition,they are said to be "medically necessary."

Accepted Answer

A) True 
 B)False

Question 12

Individuals who prefer not to enroll in original Medicare can purchase supplemental policies called Medigap or Medicare Supplement plans.

Accepted Answer

A) True 
 B)False

Question 13

Describe the difference between a participating provider and a nonparticipating provider and how the difference affects fees.

Accepted Answer

A participating provider (PAR)is one who

Question 14

When an individual purchases a healthcare policy from a commercial insurer,he or she is said to have a/an:

Accepted Answer

A)  unenforceable contract. 
B)  individual policy. 
C)  managed care plan. 
D)  both b and c 
A)  unenforceable contract. 
B)  individual policy. 
C)  managed care plan. 
D)  both b and c

Question 15

Fee-for-service health insurance policies generally limit what a patient must pay on their own,which is referred to as the:

Accepted Answer

A)  cap rate. 
B)  maximum pay. 
C)  limited amount. 
D)  out-of-pocket maximum. 
A)  cap rate. 
B)  maximum pay. 
C)  limited amount. 
D)  out-of-pocket maximum.

Question 16

The flexible spending account (FSA)is an IRS Section 125 _____________.

Accepted Answer

The answer of The flexible spending account (FSA)is an IRS...

Question 17

TRICARE is the U.S.military's comprehensive healthcare program for active duty and retired personnel.

Accepted Answer

A) True 
 B)False

Question 18

Under COBRA,employees working for qualifying employers can continue their healthcare coverage indefinitely when they leave or lose their job.

Accepted Answer

A) True 
 B)False

Question 19

A family physician,internist,obstetrician-gynecologist,or pediatrician who is usually the patient's first contact for healthcare defines a/an:

Accepted Answer

A)  participating provider. 
B)  initial provider. 
C)  primary care physician. 
D)  principal provider. 
A)  participating provider. 
B)  initial provider. 
C)  primary care physician. 
D)  principal provider.

Question 20

The traditional kind of health insurance wherein patients can choose any provider or hospital they wish and change physicians at will is:

Accepted Answer

A)  indemnity. 
B)  fee-for-service. 
C)  managed care. 
D)  both a and b 
A)  indemnity. 
B)  fee-for-service. 
C)  managed care. 
D)  both a and b

A provider who is under no contractual agreement with the insurer to accept reimbursement as payment in full.

The form that is most commonly used today for insurance claims submitted on paper is the:

Most health insurers ask that patients pay a portion (or percentage)of the charge for professional services.This charge is commonly referred to as:

Illnesses or injury that occurred before the start of a health insurance contract.

Traditional healthcare in which patients can choose any provider they want (including specialists)and change physicians at any time.

People who are covered under managed care plans are commonly referred to as:

Disability insurance is the same as workers' compensation.

Flexible spending accounts are "cafeteria" plans,meaning premiums are deducted from the employee's wages before withholding taxes are deducted.

Define the Consolidated Omnibus Budget Reconciliation Act (COBRA),who it applies to,and the provisions contained within this law.

A _____ provider is one who contracts with the insurer,agreeing to abide by certain rules and regulations of that carrier.

When medical services,procedures,or supplies meet specific criteria and are proper and needed for the diagnosis or treatment of a patient's medical condition,they are said to be "medically necessary."

Individuals who prefer not to enroll in original Medicare can purchase supplemental policies called Medigap or Medicare Supplement plans.

Describe the difference between a participating provider and a nonparticipating provider and how the difference affects fees.

When an individual purchases a healthcare policy from a commercial insurer,he or she is said to have a/an:

Fee-for-service health insurance policies generally limit what a patient must pay on their own,which is referred to as the:

The flexible spending account (FSA)is an IRS Section 125 _____________.

TRICARE is the U.S.military's comprehensive healthcare program for active duty and retired personnel.

Under COBRA,employees working for qualifying employers can continue their healthcare coverage indefinitely when they leave or lose their job.

A family physician,internist,obstetrician-gynecologist,or pediatrician who is usually the patient's first contact for healthcare defines a/an:

The traditional kind of health insurance wherein patients can choose any provider or hospital they wish and change physicians at will is:

The Origins of Health Insurance

Tools of the Trade: A Career as a Health (Medical)Insurance Professional

The Legal and Ethical Side of Medical Insurance

Claim Submission Methods

Traditional Fee For Service/Private Plans

Unraveling the Mysteries of Managed Care

Understanding Medicaid

Conquering Medicare’s Challenges

Military Carriers

Miscellaneous Carriers: Workers’ Compensation and Disability Insurance

Diagnostic Coding

Procedural, Evaluation and Management, and HCPCS Coding

The Patient

Keys to Successful Claims Management

The Role of Computers in Health Insurance

Reimbursement Procedures: Getting Paid

Hospital Billing and the UB-04

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Exam 4: Types and Sources of Health Insurance

A provider who is under no contractual agreement with the insurer to accept reimbursement as payment in full.

The form that is most commonly used today for insurance claims submitted on paper is the:

Most health insurers ask that patients pay a portion (or percentage)of the charge for professional services.This charge is commonly referred to as:

Illnesses or injury that occurred before the start of a health insurance contract.

Traditional healthcare in which patients can choose any provider they want (including specialists)and change physicians at any time.

People who are covered under managed care plans are commonly referred to as:

Disability insurance is the same as workers' compensation.

Flexible spending accounts are "cafeteria" plans,meaning premiums are deducted from the employee's wages before withholding taxes are deducted.

Define the Consolidated Omnibus Budget Reconciliation Act (COBRA),who it applies to,and the provisions contained within this law.

A _____ provider is one who contracts with the insurer,agreeing to abide by certain rules and regulations of that carrier.

When medical services,procedures,or supplies meet specific criteria and are proper and needed for the diagnosis or treatment of a patient's medical condition,they are said to be "medically necessary."

Individuals who prefer not to enroll in original Medicare can purchase supplemental policies called Medigap or Medicare Supplement plans.

Describe the difference between a participating provider and a nonparticipating provider and how the difference affects fees.

When an individual purchases a healthcare policy from a commercial insurer,he or she is said to have a/an:

Fee-for-service health insurance policies generally limit what a patient must pay on their own,which is referred to as the:

The flexible spending account (FSA)is an IRS Section 125 _____________.

TRICARE is the U.S.military's comprehensive healthcare program for active duty and retired personnel.

Under COBRA,employees working for qualifying employers can continue their healthcare coverage indefinitely when they leave or lose their job.

A family physician,internist,obstetrician-gynecologist,or pediatrician who is usually the patient's first contact for healthcare defines a/an:

The traditional kind of health insurance wherein patients can choose any provider or hospital they wish and change physicians at will is:

The Origins of Health Insurance

Tools of the Trade: A Career as a Health (Medical)Insurance Professional

The Legal and Ethical Side of Medical Insurance

Claim Submission Methods

Traditional Fee For Service/Private Plans

Unraveling the Mysteries of Managed Care

Understanding Medicaid

Conquering Medicare’s Challenges

Military Carriers

Miscellaneous Carriers: Workers’ Compensation and Disability Insurance

Diagnostic Coding

Procedural, Evaluation and Management, and HCPCS Coding

The Patient

Keys to Successful Claims Management

The Role of Computers in Health Insurance

Reimbursement Procedures: Getting Paid

Hospital Billing and the UB-04

Filters