Question 1

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 B

Question 2

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

Accepted Answer

A) True 
 B)False  TRUE

Question 3

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. A

Question 4

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 5

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 6

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

Question 7

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 8

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 9

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 10

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 11

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 12

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 13

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 14

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 15

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 16

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 17

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 18

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 19

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 20

Health insurance benefits are determined by

Accepted Answer

A)  indemnity schedules. 
B)  service benefit plans. 
C)  relative value studies. 
D)  All of the above 
A)  indemnity schedules. 
B)  service benefit plans. 
C)  relative value studies. 
D)  All of the above

Exam 14: Basics of Health Insurance

Medigap polices cover which of the following?

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

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

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

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?

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

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.

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

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

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?

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)

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

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

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

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

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

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

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

Health insurance benefits are determined by

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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