Deck 2: Introduction to Health Insurance

Question 1

Which includes the identification of disease and the provision of care and treatment to persons who are sick, injured, or concerned about their health status?

A) health insurance
B) medical care
C) preventive care
D) third-party payment

Answer 1

medical care

Question 2

Which type of health insurance coverage has costs that are typically less per person and provides broader coverage?

A) group health insurance
B) individual health insurance
C) public health insurance
D) universal health insurance

Answer 2

group health insurance

Question 3

Which legislation provides civilian employees of the federal government with medical care, survivors' benefits, and compensation for lost wages?

A) Federal Civil Defense Act
B) Federal Employees' Compensation Act
C) Federal Employers' Liability Act
D) Federal Unemployment Tax Act

Answer 3

Federal Employees' Compensation Act

Question 4

Which party signs a contract with a health insurance company and thus, owns the health insurance policy?

A) dependent
B) patient
C) payer
D) policyholder

Question 5

Which serves as a system of checks and balances for labor and management?

A) health insurance exchange
B) medical underwriter
C) preferred provider organization
D) third-party administrator

Question 6

Which classification system was developed by the World Health Organization and used to collect data for statistical purposes?

A) Current Procedural Terminology
B) Healthcare Common Procedure Coding System
C) International Classification of Diseases
D) National Drug Codes

Question 7

Which provides coverage for catastrophic or prolonged illnesses and injuries?

A) health insurance marketplace
B) indemnity health plans
C) major medical insurance
D) state mandated benefits

Question 8

Which provides health insurance coverage?

A) continuity of care
B) health insurance exchange
C) meaningful use
D) third-party payer

Question 9

Which type of insurance has as its goal providing every individual with access to health coverage, regardless of the system implemented to achieve that goal?

A) group health insurance
B) individual health insurance
C) public health insurance
D) universal health insurance

Question 10

Which act provided federal grants for modernizing hospitals that had become obsolete because of a lack of capital investment during the Great Depression and World War II (1929 to 1945)?

A) Brady Act
B) Gramm-Leach-Bliley Act
C) Hill-Burton Act
D) Taft-Hartley Act

Question 11

Which is a centralized health care system adopted by some Western nations (e.g., Canada, Great Britain) and funded by taxes?

A) individual health insurance
B) single-payer plan
C) socialized medicine
D) universal health insurance

Question 12

Which is the amount for which the patient is financially responsible before an insurance policy provides payment?

A) coinsurance
B) copayment
C) deductible
D) exclusionary

Question 13

Which may specifically result in the early detection of health problems, allowing less drastic and less expensive treatment options?

A) health care insurance
B) medical necessity
C) preventive examination
D) third-party payment

Question 14

Which legislation protects and compensates railroad workers who are injured on the job?

A) Federal Civil Defense Act
B) Federal Employees' Compensation Act
C) Federal Employers' Liability Act
D) Federal Unemployment Tax Act

Question 15

Which type of health insurance coverage is subsidized by employers and other organizations?

A) group health insurance
B) individual health insurance
C) public health insurance
D) universal health insurance

Question 16

Title XIX of the Social Security Amendments of 1965 is a cost-sharing program between the federal and state governments to provide health care services to low-income Americans. It is a government plan known as __________.

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

Question 17

Which type of health insurance coverage includes federal and state government health programs (e.g., Medicare, Medicaid, SCHIP, TRICARE) that are available to eligible individuals?

A) group health insurance
B) individual health insurance
C) public health insurance
D) universal health insurance

Question 18

A lifetime maximum amount is the maximum benefits payable to a __________.

A) health plan participant
B) nonparticipating provider
C) participating provider
D) third-party payer

Question 19

Which type of health insurance coverage is purchased by families who do not have access to employer-subsidized coverage?

A) group health insurance
B) individual health insurance
C) public health insurance
D) universal health insurance

Question 20

Which is a type of single-payer system in which the government owns and operates health care facilities and providers (e.g., physicians) receive salaries?

A) government health plan
B) managed care
C) socialized medicine
D) universal health insurance

Question 21

The Veterans Healthcare Expansion Act of 1973 authorized Veterans Affairs to establish __________ to provide health care benefits for dependents of veterans rated as 100 percent permanently and totally disabled as a result of service-connected conditions, veterans who died as a result of service-connected conditions, and veterans who died on duty with less than 30 days of active service.

A) CHAMPUS
B) CHAMPVA
C) Medicaid and Medicare
D) TRICARE

Question 22

Which act governs privacy, security, and electronic transactions standards for health care information and was implemented to provide better access to health insurance, limit fraud and abuse, and reduce administrative costs?

A) BBA
B) HIPAA
C) MMA
D) TEFRA

Question 23

Amendments to the Dependents' Medical Care Act of 1956 created the Civilian Health and Medical Program-Uniformed Services (CHAMPUS), which was designed as a benefit for dependents of personnel serving in the armed forces as well as uniformed branches of the Public Health Service and the National Oceanic and Atmospheric Administration. The program is now called __________.

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

Question 24

Prior to implementation of a prospective payment system for acute care hospital inpatient stays, reimbursement was generated on a __________ basis, which issued payment based on daily rates.

A) capitated
B) per diem
C) prospective
D) res gestae

Question 25

The Outpatient Prospective Payment System (OPPS), which uses __________ to calculate reimbursement, is implemented for billing of hospital-based Medicare outpatient claims.

A) ambulatory payment classifications
B) diagnosis-related groups
C) outcomes and assessment information
D) resource utilization groups

Question 26

The CHAMPUS Reform Initiative (CRI) of 1988 resulted in a new program called TRICARE, which includes __________.

A) certificates of insurance
B) group health insurance
C) health care marketplaces
D) multiple options

Question 27

The National Correct Coding Initiative (NCCI) was created to promote national correct coding methodologies and to eliminate __________ coding.

A) credentialed
B) improper
C) outdated
D) provider

Question 28

The Financial Services Modernization Act (FSMA) (or Gramm-Leach-Bliley Act) prohibits sharing of medical information among health insurers and other financial institutions for use in making __________ decisions.

A) credit
B) financial
C) payment
D) reimbursement

Question 29

Large employers who assume the financial risk for providing health care benefits to employees do not pay a fixed premium to a health insurance payer, but establish a trust fund (of employer and employee contributions) out of which claims are paid. This concept is called __________.

A) capitation
B) managed care
C) self-insurance
D) underwriting

Question 30

The Home Health Prospective Payment System (HH PPS) reimburses home health agencies at a __________ rate for health care services provided to patients.

A) fee-based
B) predetermined
C) retrospective
D) usual and customary

Question 31

The Resource-Based Relative Value Scale (RBRVS) system reimburses physicians' practice expenses using a __________.

A) fee schedule
B) guaranteed issue method
C) prospective payment system
D) usual and reasonable payment basis

Question 32

The State Children's Health Insurance Program (SCHIP) was established to provide health assistance to uninsured, low-income children, either through separate programs or through expanded eligibility under state __________ programs.

A) CHAMPUS
B) CHAMPVA
C) Medicaid
D) Medicare

Question 33

Which is the abbreviation for the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 that required implementation of a $400 billion prescription drug benefit, improved Medicare Advantage (formerly called Medicare+Choice) benefits, required faster Medicare appeals decisions, and more?

A) BIPA
B) M-BIPA
C) M-Part-C
D) MMS-BIPA

Question 34

CPT includes a section called Evaluation and Management (E/M), which describes patient encounters with providers for the purpose of the evaluation and management of __________.

A) general health status
B) lifetime insurance benefits
C) preadmission testing
D) surgical procedures

Question 35

Clinical Laboratory Improvement Act (CLIA) legislation established __________ for all laboratory testing to ensure the accuracy, reliability, and timeliness of patient test results regardless of where the test was performed.

A) advance directives
B) case management
C) plan administration
D) quality standards

Question 36

Which act allows employees to continue health care coverage beyond the benefit termination date?

A) Consolidated Omnibus Budget Reconciliation Act of 1985
B) Health Insurance Portability and Accountability Act of 1996
C) Omnibus Budget Reconciliation Act of 1981
D) Tax Equity and Fiscal Responsibility Act of 1982

Question 37

Medicare requires providers to submit the __________ claim for payment of outpatient and office services.

A) CMS-1450
B) CMS-1500
C) UB-02
D) UB-04

Question 38

The Skilled Nursing Facility Prospective Payment System (SNF PPS) was implemented to cover all costs (routine, ancillary, and capital) related to services furnished to Medicare Part A beneficiaries. SNF PPS generates per diem payments for each admission. These payments are case-mix adjusted using a resident classification system called __________.

A) diagnosis-related groups
B) minimum data set
C) outcomes and assessment information set
D) resource utilization groups

Question 39

Which act mandated reporting and disclosure requirements for group life and health plans (including managed care plans), permitted large employers to self-insure employee health care benefits, and exempted large employers from taxes on health insurance premiums?

A) Employee Retirement Income Security Act of 1974
B) Health Maintenance Organization Assistance Act of 1973
C) Omnibus Budget Reconciliation Act of 1981
D) Tax Equity and Fiscal Responsibility Act of 1982

Question 40

Which act resulted in a prospective payment system (PPS) that issues a predetermined payment for inpatient services?

A) Employee Retirement Income Security Act of 1974
B) Health Maintenance Organization Assistance Act of 1973
C) Omnibus Budget Reconciliation Act of 1981
D) Tax Equity and Fiscal Responsibility Act of 1982

Question 41

The American Recovery and Reinvestment Act of 2009 (ARRA) established electronic health record (EHR) __________ during three stages to achieve the goal of improved patient care outcomes and delivery as well as data capture and sharing, advance clinical processes, and improved outcomes.

A) acquisition of health information technology systems
B) health care reform initiatives
C) meaningful use objectives and measures
D) privacy and security requirements

Question 42

The Medicare Contracting Reform initiative (MCR) was established to integrate the administration of Medicare Parts A and B fee-for-service benefits with new entities called __________.

A) carriers
B) fiscal intermediaries
C) Medicare administrative contractors
D) third-party payers

Question 43

Which is a global concept that includes the collection of patient information documented by a number of providers at different facilities regarding one patient?

A) electronic health record
B) electronic medical record
C) multidisciplinary health record
D) personal health record

Question 44

POR progress notes are documented for each problem assigned to the patient, using the SOAP format. When the patient states, "I have had a stuffy nose and sore throat for about one week," the provider documents the statement in the __________ portion of the progress note.

A) Subjective
B) Objective
C) Assessment
D) Plan

Question 45

Which is a systematic method of documentation that consists of four components: database, problem list, initial plan, and progress notes?

A) electronic record
B) integrated record
C) problem-oriented record
D) source-oriented record

Question 46

Which was created by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) to identify and recover improper Medicare payments paid to health care providers under fee-for-service Medicare plans?

A) government health care program
B) medical audit program
C) quality assurance program
D) recovery audit contractor program

Question 47

The Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) includes a patient classification system that reflects differences in patient __________.

A) assessments and income
B) case- and facility-level adjustments
C) outcomes and assessment information
D) resource use and costs

Question 48

The Patient Protection and Affordable Care Act (PPACA) was signed into federal law on March 23, 2010, and resulted in the creation of a Health Insurance Marketplace to:

A) ​allow Americans to purchase health coverage that fits their budget and meets their needs.
B) ​create the Obama care federal national health insurance program.
C) ​replace other health insurance programs, such as private insurance.
D) ​require employers to offer group health insurance to all employees.

Question 49

Total practice management software is used to generate the electronic medical record, automating which of the following medical practice functions?

A) appointment scheduling
B) collecting bad debts
C) patient check writing
D) third-party payer reimbursement

Question 50

Which documents health care services provided to a patient and includes patient demographic (or identification) data, documentation to support diagnoses and justify treatment provided, and the results of treatment provided?

A) accounting system
B) financial documents
C) health insurance claim
D) patient record

Question 51

Which was introduced in 2000 as a way to encourage individuals to locate the best health care at the lowest possible price with the goal of holding down health care costs?

A) bronze plans
B) consumer-driven health plans
C) employee assistant programs
D) health insurance exchanges

Question 52

The Health Care and Education Reconciliation Act (HCERA) amended the PPACA to implement health care reform initiatives, which included __________.

A) closing the Medicare "donut hole"
B) decreasing tax credits to buy health insurance
C) eliminating revenue changes on indoor tanning services
D) increasing special deals provided to senators

Question 53

The Investing in Innovations (i2) Initiative is designed to spur innovations in health information technology (health IT) by promoting research and development to enhance competitiveness in the United States. An example of this type of an initiative includes _____.

A) facilitating the exchange of health information by prohibiting individuals from customizing privacy allowances for their personal health records
B) generating results by providing patients, caregivers, and clinicians with access to rigorous and relevant information that can support real needs and immediate decisions
C) permitting the unsecured and effective sharing of information by individuals with members of their social network
D) prohibiting individuals from connecting with others during natural disasters and other periods of emergency

Question 54

The Health Information Technology for Economic and Clinical Health Act was included in the American Recovery and Reinvestment Act of 2009 and amended the Public Health Service Act to establish the __________.

A) Health Care Financing Administration
B) Centers for Medicare and Medicaid Services
C) Office of National Coordinator for HIT
D) State Children's Health Insurance Program

Question 55

The Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) utilizes information from a __________ to classify patients into distinct groups based on clinical characteristics and expected resource needs.

A) defined contribution plan
B) minimum data set
C) patient assessment instrument
D) resource utilization group

Question 56

The primary purpose of the patient record is to provide for __________ of care, which involves documenting patient care services so that others who treat the patient have a source of information to assist with additional care and treatment.

A) continuity
B) provision
C) quality
D) reimbursement

Question 57

Which currently performs utilization and quality control review of health care furnished, or to be furnished, to Medicare beneficiaries?

A) focus review organizations
B) peer review organizations
C) professional standard review organizations
D) quality review organizations

Question 58

Which has a more narrow focus because it is the patient record created for a single medical practice using a computer, keyboard, mouse, optical pen device, voice recognition system, scanner, and/or touch screen?

A) electronic health record
B) electronic medical record
C) multidisciplinary health record
D) personal health record

Question 59

One result of the Patient Protection and Affordable Care Act (PPACA) was establishment of state health insurance __________ that Americans will use to purchase health coverage that fits their budget and meets their needs.

A) exchanges or marketplaces
B) payment or reimbursement systems
C) requirements or regulations
D) statutes or laws