Question 1

TRICARE is a form of government insurance for veterans of the U.S. armed forces.

Accepted Answer

A) True 
 B)False

Question 2

Health insurance designed for military dependents and retired military personnel is called

Accepted Answer

A)  CHAMPVA. 
B)  TRICARE. 
C)  Medicare. 
D)  Medicaid. 
A)  CHAMPVA. 
B)  TRICARE. 
C)  Medicare. 
D)  Medicaid.

Question 3

Which of the following managed care plans require preauthorization for medical services such as surgery?

Accepted Answer

A)  HMOs 
B)  PPOs 
C)  EPOs 
D)  Both A and B 
E)  All of the above 
A)  HMOs 
B)  PPOs 
C)  EPOs 
D)  Both A and B 
E)  All of the above

Question 4

Which type of HMO model consists of physicians with separately owned practices who formally organize into a group but continue to practice in their own offices?

Accepted Answer

A)  Staff model 
B)  Independent practice association 
C)  Group model 
D)  None of the above 
A)  Staff model 
B)  Independent practice association 
C)  Group model 
D)  None of the above

Question 5

The amount of money paid to keep an insurance policy in force is the

Accepted Answer

A)  premium. 
B)  deductible. 
C)  co-pay. 
D)  co-insurance. 
A)  premium. 
B)  deductible. 
C)  co-pay. 
D)  co-insurance.

Question 6

The physician who enters into a contract with an insurance company and agrees to certain rules and regulations is called a ______ provider.

Accepted Answer

A)  participating 
B)  paying 
C)  physician 
D)  None of the above 
A)  participating 
B)  paying 
C)  physician 
D)  None of the above

Question 7

Veterans of the U.S. armed forces may be covered by

Accepted Answer

A)  CHAMPVA. 
B)  TRICARE. 
C)  workers' compensation. 
D)  Blue Cross/Blue Shield. 
A)  CHAMPVA. 
B)  TRICARE. 
C)  workers' compensation. 
D)  Blue Cross/Blue Shield.

Question 8

Most of today's health insurance policies cover which of the following?

Accepted Answer

A)  Preventive care 
B)  Procedures deemed medically necessary 
C)  Elective procedures 
D)  All of the above 
E)  Both A and B 
A)  Preventive care 
B)  Procedures deemed medically necessary 
C)  Elective procedures 
D)  All of the above 
E)  Both A and B

Question 9

Which part of Medicare covers prescription drug services?

Accepted Answer

A)  A 
B)  B 
C)  C 
D)  D 
A)  A 
B)  B 
C)  C 
D)  D

Question 10

Which of the following MCOs typically has/have the lowest monthly premiums with lower patient financial responsibility?

Accepted Answer

A)  Medicare/Medicaid 
B)  PPOs 
C)  HMOs 
D)  BC/BS 
E)  IPA 
A)  Medicare/Medicaid 
B)  PPOs 
C)  HMOs 
D)  BC/BS 
E)  IPA

Question 11

If Mr. Jones's insurance has a $500 deductible and a $50 surgery co-pay and then pays 80% of the charges, how much will his policy pay on his bill of $4,359?

Accepted Answer

A)  $3027.20 
B)  $3047.20 
C)  $3047.00 
D)  $3067.50 
A)  $3027.20 
B)  $3047.20 
C)  $3047.00 
D)  $3067.50

Question 12

Which of the following is not an advantage of managed care?

Accepted Answer

A)  Healthcare costs are usually contained. 
B)  Access to specialized care and referrals is limited. 
C)  Most preventive medical treatment is covered. 
D)  Out-of-pocket expenses tend to be less than traditional insurance. 
A)  Healthcare costs are usually contained. 
B)  Access to specialized care and referrals is limited. 
C)  Most preventive medical treatment is covered. 
D)  Out-of-pocket expenses tend to be less than traditional insurance.

Question 13

Which of the following are not reviewed by a utilization review committee?

Accepted Answer

A)  Physician referrals 
B)  Cases of emergency department visits and urgent care 
C)  Individual cases to ensure medical care services are medically necessary 
D)  Fees for services provided 
A)  Physician referrals 
B)  Cases of emergency department visits and urgent care 
C)  Individual cases to ensure medical care services are medically necessary 
D)  Fees for services provided

Question 14

The maximum amount of money third-party payers will pay for a specific procedure or service is called the

Accepted Answer

A)  benefit. 
B)  allowable amount. 
C)  allowed service. 
D)  incurred amount. 
A)  benefit. 
B)  allowable amount. 
C)  allowed service. 
D)  incurred amount.

Question 15

Under which of the following Medicare plans for primary care and specialists' services is the patient required to pay a monthly premium?

Accepted Answer

A)  Part A 
B)  Part B 
C)  Part C 
D)  Part D 
A)  Part A 
B)  Part B 
C)  Part C 
D)  Part D

Question 16

Medigap polices cover which of the following?

Accepted Answer

A)  Difference between major medical reimbursement and patient financial responsibilities 
B)  Difference between Medicare reimbursement and patient financial responsibilities 
C)  Any services not covered under Medicare 
D)  Any services not covered under Major medical 
A)  Difference between major medical reimbursement and patient financial responsibilities 
B)  Difference between Medicare reimbursement and patient financial responsibilities 
C)  Any services not covered under Medicare 
D)  Any services not covered under Major medical

Question 17

A review of individual cases by a committee to make sure that services are medically necessary and to study how providers use medical care resources is called a(n)

Accepted Answer

A)  credentialing committee review. 
B)  peer review committee evaluation. 
C)  utilization review. 
D)  audit committee review. 
A)  credentialing committee review. 
B)  peer review committee evaluation. 
C)  utilization review. 
D)  audit committee review.

Question 18

A type of insurance that protects workers from loss of wages after an industrial accident that happened on the job is called

Accepted Answer

A)  an individual policy. 
B)  workers' compensation. 
C)  unemployment insurance. 
D)  disability insurance. 
A)  an individual policy. 
B)  workers' compensation. 
C)  unemployment insurance. 
D)  disability insurance.

Question 19

Which of the following individuals would not normally be eligible for Medicare?

Accepted Answer

A)  A 66-year-old retired woman 
B)  A blind teenager 
C)  A 23-year-old recipient of AFDC 
D)  A person on dialysis 
A)  A 66-year-old retired woman 
B)  A blind teenager 
C)  A 23-year-old recipient of AFDC 
D)  A person on dialysis

Question 20

Organizations that fund their own insurance programs offer their employees

Accepted Answer

A)  group coverage. 
B)  individual coverage. 
C)  government plans. 
D)  self-funded plans. 
A)  group coverage. 
B)  individual coverage. 
C)  government plans. 
D)  self-funded plans.

Exam 14: Basics of Health Insurance

TRICARE is a form of government insurance for veterans of the U.S. armed forces.

Health insurance designed for military dependents and retired military personnel is called

Which of the following managed care plans require preauthorization for medical services such as surgery?

Which type of HMO model consists of physicians with separately owned practices who formally organize into a group but continue to practice in their own offices?

The amount of money paid to keep an insurance policy in force is the

The physician who enters into a contract with an insurance company and agrees to certain rules and regulations is called a ______ provider.

Veterans of the U.S. armed forces may be covered by

Most of today's health insurance policies cover which of the following?

Which part of Medicare covers prescription drug services?

Which of the following MCOs typically has/have the lowest monthly premiums with lower patient financial responsibility?

If Mr. Jones's insurance has a $500 deductible and a $50 surgery co-pay and then pays 80% of the charges, how much will his policy pay on his bill of $4,359?

Which of the following is not an advantage of managed care?

Which of the following are not reviewed by a utilization review committee?

The maximum amount of money third-party payers will pay for a specific procedure or service is called the

Under which of the following Medicare plans for primary care and specialists' services is the patient required to pay a monthly premium?

Medigap polices cover which of the following?

A review of individual cases by a committee to make sure that services are medically necessary and to study how providers use medical care resources is called a(n)

A type of insurance that protects workers from loss of wages after an industrial accident that happened on the job is called

Which of the following individuals would not normally be eligible for Medicare?

Organizations that fund their own insurance programs offer their employees

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

Assisting in Gastroenterology

Assisting in Urology and Male Reproduction

Assisting in Obstetrics and Gynecology

Assisting in Pediatrics

Assisting in Orthopedic Medicine

Assisting in Neurology and Mental Health

Assisting in Endocrinology

Assisting in Pulmonary Medicine

Assisting in Cardiology

Assisting in Geriatrics

Principles of Electrocardiography

Assisting With Diagnostic Imaging

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

Career Development and Life Skills

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