Deck 1: From Patient to Payment Understanding Medical Insurance

Question 1

In exchange for the premium that the policyholder pays, the health plan agrees to pay amounts for medical services called _______.

A) premium
B) benefits
C) deductible
D) coinsurance

Answer 1

B
In exchange for the premium that the policyholder pays, the health plan agrees to pay amounts for medical services called benefits.

Question 2

___________ is the percentage of the charges an insured person must pay for health care services after the deductible has been met.

A) coinsurance
B) indemnity
C) compensation
D) capitation

Answer 2

A
Coinsurance is the percentage of charges an insured person must pay for health care services after the deductible. The coinsurance rate state the amount the health plan percentage of the charge followed by the insured's percentage, such as 80/20

Question 3

Coinsurance is paid by the ______.

A) policyholder
B) provider
C) insurance company
D) government

Answer 3

A
Coinsurance is paid by the policyholder.

Question 4

______ is the amount that a person insured in a managed care plan must pay for each office visit.

A) Compensation
B) Copayment
C) Stipend
D) Discount

Question 5

Cost-containment practices are designed to __________.

A) drive up health care costs.
B) hold down health care costs
C) have no effect on health care costs
D) increase health care costs over a designated period

Question 6

_____ is the amount the insured must pay before receiving benefits from the insurance policy.

A) deductible
B) payment to referring physician
C) benefits
D) optional service fees

Question 7

A person who is also covered under an insured person's policy is called a(n) ______.

A) person living in the household
B) coinsurance holder
C) coworker
D) dependent

Question 8

A provider's analysis of a patient's illness or injury is called ____.

A) objective information
B) subjective information
C) fees for service
D) diagnosis

Question 9

____ is a health plan document that provides details about how a patient's claim was handled.

A) remittance advice
B) encounter form
C) adjudication
D) medical record

Question 10

_____ are benefits paid based on the fees physician charge for the services.

A) reimbursement
B) calculated costs
C) government services
D) fee-for-service

Question 11

______ is a formal insurance claim, either electronic or hard copy format, which is filed with the payer (insurance carrier) by many medical offices on behalf of their patients to receive payments.

A) Health care claim
B) Benefits package
C) Stipend request
D) Voucher claim

Question 12

____ are organizations that offer financial protection in case of illness or accidental injury.

A) National organization of employees
B) Banks
C) Health plans
D) Vouchers

Question 13

___ are organizations that offer health plans that combine the financing and delivery of health care services.

A) fees-for services
B) managed care organizations
C) company benefits
D) vouchers for health care

Question 14

___ is a financial plan that covers the cost of hospitalization and medical care due to illness or injury.

A) adjunction
B) premium
C) compensation
D) medical insurance

Question 15

____ is a form that contains demographic information about a patient.

A) remittance advice
B) reimbursement form
C) insurance card
D) patient information form

Question 16

____ is a person who buys an insurance plan.

A) Dependent
B) Insurance Agent
C) Company Accountant
D) Policyholder

Question 17

When a health plan has approved a procedure before it is done, this process is called____.

A) preauthorization
B) fees-for-services
C) adjunction
D) premium

Question 18

A _____ is a person or entity that supplies medical or health services.

A) provider
B) benefactor
C) donor
D) contributor

Question 19

A list of covered services that an insurance policy covers is called ____.

A) remittance form
B) schedule of benefits
C) agenda form
D) timetable of benefits

Question 20

___ are medical procedures and treatments included as benefits in a health plan.

A) Proposal of services
B) Organization of benefits
C) Diagrams of treatments
D) Covered services

Question 21

___ is a small fixed fee paid by the policyholder/patient at the time of each office visit.

A) Copayment
B) Stipend
C) Voucher
D) Discount

Question 22

___ is the third party in the medical insurance relationship who carries some of the risk of paying for services on the behalf of the beneficiaries.

A) Provider
B) Dependent
C) Payer
D) Wage-earner

Question 23

___ are private or government organizations that insure or pay for health care on behalf of beneficiaries.

A) Payers
B) Health care professionals
C) Beneficiaries
D) Providers

Question 24

Medically necessary means ______.

A) the patient's diagnosis and procedures received are logically linked
B) the patient needs the elective treatment
C) the patient's diagnosis needs a second opinion
D) the patient's procedures need a second opinion

Question 25

___ means treatments that are appropriate and rendered in accordance with generally accepted standards of medical practice.

A) standards of practice
B) accreditation
C) endorsement
D) medically necessary

Question 26

___ are the standards of behavior requiring truthfulness, honesty, and integrity.

A) philosophies
B) certification criteria
C) ethics
D) ideologies

Question 27

___ are standards of conduct based on moral principles.

A) ethics
B) conventions
C) norms
D) routines

Question 28

Workers' compensation covers people with _____.

A) job-related illnesses and injuries
B) illness and injuries that occurred on vacation
C) only illnesses
D) only accidents

Question 29

People with job-related illnesses or injuries are covered under workers' compensation insurance through _____.

A) private companies
B) state insurance
C) their employer
D) paycheck deduction

Question 30

Preregistration involves _____.

A) scheduling appointments
B) gathering basic demographic and insurance information about patients
C) taking the patients vital signs
D) taking X-rays

Question 31

Patient payments such as copayments are ____.

A) part of the patient checkout process
B) part of the scheduling process
C) part of the Coding process
D) part of the Compliance process

Question 32

Revenue cycle management (RCM) involves ____.

A) actions that help to ensure the provider receives maximum appropriate payment
B) movement of monies to a clearinghouse
C) actions to ensure that the practice is compliant with the insurance companies
D) government standards of payment

Question 33

Health information technology is ___.

A) computer software that is used for payroll within the medical office
B) computer software used to control the health care environment
C) computer hardware and software information systems that record, store, and manage patient information
D) computer hardware to evaluate employees

Question 34

Practice management programs (PMPs) are ____.

A) software programs used to monitor equipment used in the medical office
B) software used to monitor patient vital signs
C) specialized software used to manage building security
D) specialized accounting software programs used in many medical offices

Question 35

Practice management programs (PMPs) are used to ____.

A) record certification of the medical office staff
B) bill insurance companies and patients
C) monitor the equipment used in the medical office
D) evaluate employees

Question 36

An electronic health record (EHR) is a ___.

A) computerized record of a single visit with a physician
B) computerized lifelong health care record for an individual
C) computerized record of the patient's financial transactions
D) computerized record of only childhood tests

Question 37

Health plans offer financial protection in the case of_____.

A) Unemployment
B) Illness
C) Divorce
D) Loss of a spouse

Question 38

A copayment is due when the patient ___.

A) next returns to the practice
B) receives the service
C) calls to join a new practice
D) has surgery

Question 39

If a policyholder owes coinsurance of 30 percent and the charges are $100, what is the amount the insurance policy will pay?

A) $50
B) $30
C) $70
D) $100

Question 40

Who pays for the excluded services?

A) insurance policy
B) provider
C) patient
D) Medicare

Question 41

In the United States, rising medical costs are due to ____.

A) increased spending on drugs
B) increase in world population
C) increased payments to providers
D) decrease of number of health care professional

Question 42

An example of ____ is requiring patients to choose from a specific group of physicians.

A) preauthorization policy
B) cost-containment practice
C) fee for service
D) managed physician organization

Question 43

Managed care plans often require preauthorization for ____.

A) emergencies
B) nonemergency hospitalizations
C) coinsurance payments
D) dental work

Question 44

Policyholders receive insurance benefits when which of the following is filed?

A) compensation forms
B) health care claims
C) encounter forms
D) patient information forms

Question 45

_____ is a type of managed care plan in which a high-deductible low-premium insurance plan is combined with a pretax savings plan.

A) primary health saving plan
B) health management plan
C) consumer-driven health plan
D) disability health plan

Question 46

Inaccurate health care claims can result in ____.

A) loss of PMR
B) denied claims
C) loss of EHR
D) increase in pay for employees

Question 47

Fees are set by ________ under a managed care plan.

A) The provider
B) The hospital
C) The managed care organization
D) The patient data form

Question 48

Copay is the shortened version of which term?

A) cooperative payment
B) company payment
C) coinsurance
D) copayment

Question 49

In a fee-for-service plan, benefits are based on the fees charged for services by ___.

A) physicians
B) CHAMPVA
C) patients
D) TRICARE

Question 50

The services and treatments given by a licensed medical professional are called ___.

A) detailed diagnoses
B) medically necessary
C) procedures
D) ethics

Question 51

Correct behavior in the medical office is called ____.

A) ethics
B) etiquette
C) medically necessary
D) HIPAA

Question 52

The government sponsored insurance program for the families of military personnel is called __.

A) TRICARE
B) Medicare
C) Medicaid
D) workers' compensation

Question 53

What should patients returning to a medical office periodically be asked to do with their patient information forms?

A) take them home
B) update them
C) fill out a new form
D) email them to the payer

Question 54

___ is the second element of a CDHP that is used to pay medical bills before the deductible has been met.

A) Stipend
B) Premium
C) Health savings account
D) Product discount card

Question 55

What side(s) of the patient's insurance identification card does a medical assistant usually scan or photocopy?

A) The front
B) Neither side
C) The back
D) Both the front and back

Question 56

____ is for individuals with lower incomes who cannot afford medical care and is cosponsored by the federal and state governments.

A) A prepaid healthcare plan
B) Medicaid
C) A sponsored plan
D) Medicare

Question 57

____ is the health plan for the dependents of veterans with permanent service-related disabilities.

A) Health Keepers
B) Blue Cross/Blue Shied
C) CHAMPVA
D) Medicaid

Question 58

___ is the health plan that covers surviving spouses and dependent children of veterans who died from service-related disabilities.

A) CHAMPVA
B) Priority One
C) Medicare
D) Health Keepers

Question 59

___ is a type of managed care health plan in which a network of providers under contract with a managed care organization agree to perform services for plan members at discounted fees.

A) Preferred Provider Organization
B) Proposed Provider Organization
C) Health Plan Organization
D) Care Provider Organization

Question 60

___ is a type of managed care system in which providers are paid fixed rates at regular intervals to provide necessary contracted services to patients who are plan members.

A) Government Employee Plan
B) State Employee Plan
C) Health Maintenance Organization
D) Preferred Provider Organization

Question 61

_____ is the illness or condition that is the reason a patient needs to see the physician.

A) Chief complaint
B) Insurance protocol
C) Insurance practice
D) Previous grievance

Question 62

Recognition of a superior level of skill by an official organization is called __.

A) Awards
B) Certification
C) Authorization
D) Validation

Question 63

____ shows services provided to a patient, total payments made, total charges, adjustments, and balance due.

A) Proposal
B) Stipend
C) Statement
D) Medical Record

Question 64

__ are claims that are prepared and sent electronically.

A) e-claims
B) Encounter forms
C) Patient Data Form
D) Electronic Mail

Question 65

PM/EHR is a software program that combines ____.

A) Procedural Codes and Diagnostic Codes
B) Payment Management and Electronic Human Resources
C) Physician Management and Electronic Health Resources
D) Electronic Health Record and Practice Management Program

Question 66

Which one of the following is considered preventive medical services?

A) Routine Cancer Screening
B) Out of State Copays
C) Annual Deductible
D) Accidents

Question 67

____ is a private or government organization that insures or pays for health care on behalf of beneficiaries.

A) Third-Party Payer
B) First Party Payer
C) Stipend Payer
D) Beneficiary

Question 68

___ are monies that are owed to the practice.

A) Account Receivable
B) Accounts Payable
C) ePayments
D) Electronic Statement

Question 69

__ are a medical practice's operating expenses.

A) Accounts to be collected
B) Accounts Receivable
C) Accounts Payable
D) Clearinghouse Payables