Question 1

Which type of referral is usually processed immediately?

Accepted Answer

A)  Regular 
B)  Urgent 
C)  STAT 
D)  All of the above 
A)  Regular 
B)  Urgent 
C)  STAT 
D)  All of the above C

Question 2

Health insurance typically covers services and procedures considered medically necessary. Most insurance policies also cover "elective" procedures, such as certain cosmetic surgeries, that are not considered medically necessary.

Accepted Answer

A) True 
 B)False  False

Question 3

Which of the following referrals can be approved online when it is submitted through the provider's Web portal to the utilization review department?

Accepted Answer

A)  Regular referral 
B)  Urgent referral 
C)  STAT referral 
D)  All of the above 
A)  Regular referral 
B)  Urgent referral 
C)  STAT referral 
D)  All of the above C

Question 4

Which of the following HMO models hires physicians and pays them a salary rather than contracting the physicians to create a network?

Accepted Answer

A)  IPA 
B)  Staff model 
C)  Group model 
D)  PPO 
A)  IPA 
B)  Staff model 
C)  Group model 
D)  PPO

Question 5

If Mr. Jones's insurance has a $500 deductible and a $50 surgery co-pay, how much will his insurance pay on his bill of $4,359?

Accepted Answer

A)  $3,809 
B)  $2,809 
C)  $3,980 
D)  $3,900 
A)  $3,809 
B)  $2,809 
C)  $3,980 
D)  $3,900

Question 6

The TRICARE option that is similar to a preferred provider network is TRICARE

Accepted Answer

A)  Prime. 
B)  Extra. 
C)  Standard. 
D)  Basic. 
A)  Prime. 
B)  Extra. 
C)  Standard. 
D)  Basic.

Question 7

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

Question 8

A policy that covers a number of people under a single master contract issued to the employer or to an association with which they are affiliated and that is not self-funded is usually called

Accepted Answer

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

Question 9

The "cafeteria-style" plan allows employers to choose the benefits they want for their respective employees.

Accepted Answer

A) True 
 B)False

Question 10

Which of the following is not a disadvantage of managed care?

Accepted Answer

A)  Authorized services usually are covered. 
B)  Physicians' choices in the treatment of patients can be limited. 
C)  More paperwork may be necessary. 
D)  Reimbursement is historically less than with traditional health insurance. 
A)  Authorized services usually are covered. 
B)  Physicians' choices in the treatment of patients can be limited. 
C)  More paperwork may be necessary. 
D)  Reimbursement is historically less than with traditional health insurance.

Question 11

Entities that make payment on an obligation or debt but are not parties of the contract that created the debt are called

Accepted Answer

A)  riders. 
B)  service benefit plans. 
C)  third-party payers. 
D)  capitation. 
A)  riders. 
B)  service benefit plans. 
C)  third-party payers. 
D)  capitation.

Question 12

A physician can choose whether to accept Medicaid patients.

Accepted Answer

A) True 
 B)False

Question 13

The federal- and state-sponsored health insurance program for the medically indigent is called

Accepted Answer

A)  Medicare. 
B)  Medicaid. 
C)  Medigap. 
D)  MediCal. 
A)  Medicare. 
B)  Medicaid. 
C)  Medigap. 
D)  MediCal.

Question 14

Employee-sponsored 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. 
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 15

A payment method in which providers are paid for each individual enrolled in a plan, regardless of whether the person sees the provider that month, is called a ______ plan.

Accepted Answer

A)  capitation 
B)  self-insured 
C)  managed care 
D)  fee-for-service 
A)  capitation 
B)  self-insured 
C)  managed care 
D)  fee-for-service

Question 16

The amount of money the policyholder pays per claim or per accident toward the total amount of an insured loss before the company will pay on the claim is known as the

Accepted Answer

A)  exclusion. 
B)  premium. 
C)  deductible. 
D)  remittance. 
A)  exclusion. 
B)  premium. 
C)  deductible. 
D)  remittance.

Question 17

Nearly all of the physician's income is derived from the insurance payments received for services rendered.

Accepted Answer

A) True 
 B)False

Question 18

Dependents of military personnel are covered by which of the following government-sponsored health insurance plans?

Accepted Answer

A)  Medicaid 
B)  Medicare 
C)  TRICARE 
D)  CHAMPVA 
E)  Workers' compensation 
A)  Medicaid 
B)  Medicare 
C)  TRICARE 
D)  CHAMPVA 
E)  Workers' compensation

Question 19

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 
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 20

Which of the following pays the hospital surgical room fee?

Accepted Answer

A)  Disability 
B)  Basic medical 
C)  Surgical 
D)  Hospital 
E)  Both C and D 
A)  Disability 
B)  Basic medical 
C)  Surgical 
D)  Hospital 
E)  Both C and D

Exam 14: Basics of Health Insurance

Which type of referral is usually processed immediately?

Health insurance typically covers services and procedures considered medically necessary. Most insurance policies also cover "elective" procedures, such as certain cosmetic surgeries, that are not considered medically necessary.

Which of the following referrals can be approved online when it is submitted through the provider's Web portal to the utilization review department?

Which of the following HMO models hires physicians and pays them a salary rather than contracting the physicians to create a network?

If Mr. Jones's insurance has a $500 deductible and a $50 surgery co-pay, how much will his insurance pay on his bill of $4,359?

The TRICARE option that is similar to a preferred provider network is TRICARE

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

A policy that covers a number of people under a single master contract issued to the employer or to an association with which they are affiliated and that is not self-funded is usually called

The "cafeteria-style" plan allows employers to choose the benefits they want for their respective employees.

Which of the following is not a disadvantage of managed care?

Entities that make payment on an obligation or debt but are not parties of the contract that created the debt are called

A physician can choose whether to accept Medicaid patients.

The federal- and state-sponsored health insurance program for the medically indigent is called

A payment method in which providers are paid for each individual enrolled in a plan, regardless of whether the person sees the provider that month, is called a ______ plan.

The amount of money the policyholder pays per claim or per accident toward the total amount of an insured loss before the company will pay on the claim is known as the

Nearly all of the physician's income is derived from the insurance payments received for services rendered.

Dependents of military personnel are covered by which of the following government-sponsored health insurance plans?

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

Which of the following pays the hospital surgical room fee?

Competency-Based Education and the Medical Assistant Student

The Medical Assistant and the Healthcare Team

Professional Behavior in the Workplace

Therapeutic Communications

Medicine and Law

Medicine and Ethics

Technology and Written Communication in the Medical Office

Telephone Techniques

Scheduling Appointments and Patient Processing

Daily Operations in the Ambulatory Care Setting

The Health Record

Basics of Diagnostic Coding

Basics of Procedural Coding

Medical Billing and Reimbursement

Patient Accounts, Collections, and Practice Management

Banking Services and Procedures

Supervision and Human Resources Management

Medical Practice Marketing and Customer Service

Infection Control

Patient Assessment

Patient Education

Nutrition and Health Promotion

Vital Signs

Assisting With the Primary Physical Examination

Principles of Pharmacology

Pharmacology Math

Administering Medications

Safety and Emergency Practices

Assisting in Ophthalmology and Otolaryngology

Assisting in Dermatology

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Assisting in Urology and Male Reproduction

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Assisting in Pediatrics

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Principles of Electrocardiography

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Assisting in the Clinical Laboratory

Assisting in the Analysis of Urine

Assisting in Blood Collection

Assisting in the Analysis of Blood

Assisting in Microbiology and Immunology

Surgical Supplies and Instruments

Surgical Asepsis and Assisting With Surgical Procedures

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