Deck 13: Health-Care Business and Operations

Question 1

In this insurance plan, the patient chooses his or her provider and pays a flat fee to the provider in network. The patient has the option of going out of network but would have to pay more out-of-pocket fees.

A) Indemnity
B) HMO
C) PPO
D) Worker's compensation

Answer 1

PPO

Question 2

These providers are not physicians, but may perform similar services.

A) BSNs
B) CMTs
C) PAs
D) EMTs

Answer 2

PAs

Question 3

A disadvantage to an HMO is

A) they are too large.
B) some areas may not have a participating physician.
C) they give too many referrals to specialists.
D) you have to pay first, and then get reimbursed.

Answer 3

some areas may not have a participating physician.

Question 4

Which of the following insurance plans allow a patient to visit almost any physician or hospital regardless of network?

A) HMO
B) Indemnity plans
C) Medicaid
D) All of the options

Question 5

Who can bill to insurance companies?

A) RNs
B) BSNs
C) LPNs
D) NPs

Question 6

Why must a healthcare professional wear an identifying badge at all times in a hospital?

A) Some people may mistake a mid-level practitioner with a physician.
B) Some people may try to fake being a physician.
C) Some people will try to gain entry by pretending to be a medical staff member.
D) Some people want access to medications for their own use.

Question 7

If an insurance plan is 80/20 after the deductible is met for in-network benefits, what kind of plan is this?

A) Indemnity
B) HMO
C) PPO
D) Workers' compensation

Question 8

Medical coverage for persons 65 and older is called

A) Medicaid.
B) Medicare.
C) Blue Cross/Blue Shield.
D) TRICARE.

Question 9

Allied health professionals include the following, except

A) OT.
B) BSN.
C) CAN.
D) CPC.

Question 10

Which part of Medicare covers prescriptions?

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

Question 11

This type of practice is a corporate structure, and shares in the expenses, profit, and risk.

A) Solo
B) Sole proprietorship
C) Associate practice
D) Group practice

Question 12

Which part of Medicare covers hospital claims?

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

Question 13

This type of practice has two or more providers that share in overhead, but do not share in the profits or losses.

A) Solo
B) Sole proprietorship
C) Associate practice
D) Group practice

Question 14

This type of practice has multiple physician working together, but only one physician owns the practice.

A) Solo
B) Sole proprietorship
C) Associate practice
D) Group practice

Question 15

Government carriers include all of the following, except

A) Medicaid.
B) Medicare.
C) Blue Cross/Blue Shield.
D) TRICARE.

Question 16

A person has both Medicaid and Medicare. Which kind of plan is this called?

A) Medicare Advance
B) "Medi-Medi"
C) CHAMPUS
D) TRICARE

Question 17

The insurance used to cover military members and their families is called

A) Medicaid.
B) Medicare.
C) Blue Cross/Blue Shield.
D) TRICARE.

Question 18

This type of provider is not required to complete full medical school and residency requirements.

A) MD
B) DO
C) Surgeon
D) OD

Question 19

A person is under the poverty level. What kind of government plan is he eligible for?

A) Medicaid
B) Medicare
C) Blue Cross/Blue Shield
D) TRICARE

Question 20

What is an advantage of a group practice?

A) Protection of assets
B) More coverage for patient care
C) Cost sharing
D) All of the options

Question 21

All of the following are federal healthcare programs, except for

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

Question 22

Which of the following insurance plan may use a "gatekeeper" to control costs?

A) HMO
B) MCO
C) PPO
D) All of the options

Question 23

Which of the following insurance plans allows patients to see any in-network provider without first obtaining a referral from the patient's primary care provider?

A) HMO
B) MCO
C) PPO
D) ERISA

Question 24

A method of billing for services rendered by nonphysician providers is called

A) copay.
B) coinsurance.
C) incident to billing.
D) third-party payer.

Question 25

A patient has an insurance policy that requires a copay of $15 and coinsurance of 80/20. Her physician charges $100 for the visit. How much will she be responsible for?

A) $15
B) $20
C) $35
D) $95