Question 1

The kind of health insurance paid for by a business entity other than the government is called:

Accepted Answer

A)  managed care. 
B)  employer-sponsored care. 
C)  commercial health insurance. 
D)  medical savings accounts. 
A)  managed care. 
B)  employer-sponsored care. 
C)  commercial health insurance. 
D)  medical savings accounts. C

Question 2

Another term for "insurance cap" is:

Accepted Answer

A)  in-between coverage. 
B)  deductible. 
C)  stop loss. 
D)  long-term care. 
A)  in-between coverage. 
B)  deductible. 
C)  stop loss. 
D)  long-term care. C

Question 3

Many Americans obtain health insurance owing to their employment through what is commonly referred to as:

Accepted Answer

A)  COBRA. 
B)  Medicare. 
C)  group insurance. 
D)  primary coverage. 
A)  COBRA. 
B)  Medicare. 
C)  group insurance. 
D)  primary coverage. C

Question 4

Prior to submitting a claim,the healthcare professional should:

Accepted Answer

A)  assume timely filing length is at least 1 year. 
B)  assume timely filing is the same for all carriers. 
C)  follow provider guidelines. 
D)  follow payer guidelines. 
A)  assume timely filing length is at least 1 year. 
B)  assume timely filing is the same for all carriers. 
C)  follow provider guidelines. 
D)  follow payer guidelines.

Question 5

Providers who do not contract with a particular insurance carrier are called nonPARs.

Accepted Answer

A) True 
 B)False

Question 6

The two basic categories of health insurance are FFS and:

Accepted Answer

A)  managed care. 
B)  group insurance. 
C)  individual policies. 
D)  health savings accounts. 
A)  managed care. 
B)  group insurance. 
C)  individual policies. 
D)  health savings accounts.

Question 7

A PAR provider agrees to accept the amount paid by the insurance carrier as "payment in full" after both the deductible and copayment have been met.

Accepted Answer

A) True 
 B)False

Question 8

Eliminating a certain specialty of health services (e.g.,vision or dental care)from coverage is called a "carve out."

Accepted Answer

A) True 
 B)False

Question 9

If a claim is denied as "untimely,":

Accepted Answer

A)  benefits will always be denied. 
B)  an appeal can be submitted in certain cases. 
C)  the patient is responsible for the entire bill. 
D)  the provider must always cancel the charges for the encounter. 
A)  benefits will always be denied. 
B)  an appeal can be submitted in certain cases. 
C)  the patient is responsible for the entire bill. 
D)  the provider must always cancel the charges for the encounter.

Question 10

One of the provisions of healthcare reform was the removal of lifetime caps on insurance.

Accepted Answer

A) True 
 B)False

Question 11

The earliest and probably best known commercial insurer in this country is:

Accepted Answer

A)  Medicare. 
B)  Medicaid. 
C)  Metropolitan Life. 
D)  Blue Cross and Blue Shield. 
A)  Medicare. 
B)  Medicaid. 
C)  Metropolitan Life. 
D)  Blue Cross and Blue Shield.

Question 12

To make sure electronic claims have been received by the payer (or clearinghouse),the health insurance professional should review the ________________,a report that the carrier normally sends after each electronic transmission.

Accepted Answer

electronic

Question 13

Prior to the passage of the Affordable Care Act,a _____________ was the most common way to provide individuals access to health insurance if the person had been denied coverage because of a preexisting condition and had been without coverage for a period of at least 6 months.

Accepted Answer

high-risk

Question 14

Most healthcare providers in the United States accept Blue Cross and Blue Shield patients.

Accepted Answer

A) True 
 B)False

Question 15

The federal act that sets minimum standards for pension plans for private industry is:

Accepted Answer

A)  ERISA. 
B)  COBRA. 
C)  CHAMPVA. 
D)  EMTALA. 
A)  ERISA. 
B)  COBRA. 
C)  CHAMPVA. 
D)  EMTALA.

Question 16

The Affordable Care Act requires that plans sold to individuals and small businesses provide a minimum package of services in 10 categories called

Accepted Answer

A)  The 10 basic benefits package 
B)  Essential health benefits 
C)  Comprehensive groups 
D)  Medically necessary assistance 
A)  The 10 basic benefits package 
B)  Essential health benefits 
C)  Comprehensive groups 
D)  Medically necessary assistance

Question 17

The time limit for filing claims:

Accepted Answer

A)  is 60 days. 
B)  is 120 days. 
C)  is 1 year. 
D)  varies among payers. 
A)  is 60 days. 
B)  is 120 days. 
C)  is 1 year. 
D)  varies among payers.

Question 18

Explain the function of a fiscal intermediary/Medicare administrative contractor.

Accepted Answer

A fiscal intermediary (FI)is a commercia

Question 19

A document prepared by the carrier that gives details of how the claim was adjudicated is called a/an ________________.

Accepted Answer

explanation of benefits (EOB);

Question 20

Name the three out-of-pocket costs in a fee-for-service plan.

Accepted Answer

Premiums
D

The kind of health insurance paid for by a business entity other than the government is called:

Another term for "insurance cap" is:

Many Americans obtain health insurance owing to their employment through what is commonly referred to as:

Prior to submitting a claim,the healthcare professional should:

Providers who do not contract with a particular insurance carrier are called nonPARs.

The two basic categories of health insurance are FFS and:

A PAR provider agrees to accept the amount paid by the insurance carrier as "payment in full" after both the deductible and copayment have been met.

Eliminating a certain specialty of health services (e.g.,vision or dental care)from coverage is called a "carve out."

If a claim is denied as "untimely,":

One of the provisions of healthcare reform was the removal of lifetime caps on insurance.

The earliest and probably best known commercial insurer in this country is:

To make sure electronic claims have been received by the payer (or clearinghouse),the health insurance professional should review the ________________,a report that the carrier normally sends after each electronic transmission.

Prior to the passage of the Affordable Care Act,a _____________ was the most common way to provide individuals access to health insurance if the person had been denied coverage because of a preexisting condition and had been without coverage for a period of at least 6 months.

Most healthcare providers in the United States accept Blue Cross and Blue Shield patients.

The federal act that sets minimum standards for pension plans for private industry is:

The Affordable Care Act requires that plans sold to individuals and small businesses provide a minimum package of services in 10 categories called

The time limit for filing claims:

Explain the function of a fiscal intermediary/Medicare administrative contractor.

A document prepared by the carrier that gives details of how the claim was adjudicated is called a/an ________________.

Name the three out-of-pocket costs in a fee-for-service plan.

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

Types and Sources of Health Insurance

Claim Submission Methods

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

Exam 6: Traditional Fee For Service/Private Plans

The kind of health insurance paid for by a business entity other than the government is called:

Another term for "insurance cap" is:

Many Americans obtain health insurance owing to their employment through what is commonly referred to as:

Prior to submitting a claim,the healthcare professional should:

Providers who do not contract with a particular insurance carrier are called nonPARs.

The two basic categories of health insurance are FFS and:

A PAR provider agrees to accept the amount paid by the insurance carrier as "payment in full" after both the deductible and copayment have been met.

Eliminating a certain specialty of health services (e.g.,vision or dental care)from coverage is called a "carve out."

If a claim is denied as "untimely,":

One of the provisions of healthcare reform was the removal of lifetime caps on insurance.

The earliest and probably best known commercial insurer in this country is:

To make sure electronic claims have been received by the payer (or clearinghouse),the health insurance professional should review the ________________,a report that the carrier normally sends after each electronic transmission.

Prior to the passage of the Affordable Care Act,a _____________ was the most common way to provide individuals access to health insurance if the person had been denied coverage because of a preexisting condition and had been without coverage for a period of at least 6 months.

Most healthcare providers in the United States accept Blue Cross and Blue Shield patients.

The federal act that sets minimum standards for pension plans for private industry is:

The Affordable Care Act requires that plans sold to individuals and small businesses provide a minimum package of services in 10 categories called

The time limit for filing claims:

Explain the function of a fiscal intermediary/Medicare administrative contractor.

A document prepared by the carrier that gives details of how the claim was adjudicated is called a/an ________________.

Name the three out-of-pocket costs in a fee-for-service plan.

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

Types and Sources of Health Insurance

Claim Submission Methods

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