MOA 183 - Medical Billing and Coding » Fall 2020 » Chapter 2 Quiz
Need help with your exam preparation?
Get Answers to this exam for $6 USD.
Get Answers to all exams in [ MOA 183 - Medical Billing and Coding ] course for $25 USD.
Existing Quiz Clients Login here
Question #1
Terms that refer to fees in an insurance contract include all of the following EXCEPT:
A.
ordinary.
B.
customary.
C.
reasonable.
D.
usual.
Question #2
Utilization guidelines are used to:
A.
determine if services are medically necessary.
B.
determine if the provider is in the network.
C.
determine if an employee is covered under the plan.
D.
determine if care is provided by the most appropriate provider.
Question #3
Which of the following plan types does not use a network of providers?
A.
PPO plan
B.
Indemnity plan
C.
HMO plan
D.
EPO plan
Question #4
All the following are true regarding HMOs EXCEPT:
A.
regulated by federal and state law.
B.
the least restrictive type of care plan.
C.
encourage preventative health services.
D.
require a referral for specialist services.
Question #5
Beginning in 2014, employers with 50 or more workers who do not offer coverage will be fined what amount for each employee?
A.
$2,000
B.
$250
C.
$1,000
D.
$500
Question #6
The most restrictive type of managed care plan is the:
A.
exclusive provider organization (EPO).
B.
preferred provider organization (PPO).
C.
health maintenance organization (HMO).
D.
individual practice association (IPA).
Question #7
All of the following are government plans under the Affordable Care Act EXCEPT:
A.
titanium
B.
silver.
C.
catastrophic.
D.
bronze.
Question #8
The type of health maintenance organization (HMO) plan that involves contracting with individual physicians to create a healthcare delivery system is a(n):
A.
group model.
B.
network model.
C.
individual practice association (IPA) model.
D.
staff model.
Question #9
The type of health maintenance organization (HMO) plan that employs salaried physicians who treat members in facilities owned and operated by the HMO is a(n):
A.
group model.
B.
staff model.
C.
network model.
D.
individual practice association (IPA) model.
Question #10
The type of health maintenance organization (HMO) that contracts with more than one community-based multispecialty group to provide wider geographical coverage is a(n):
A.
group model.
B.
individual practice association (IPA) model.
C.
network model.
D.
staff model.
Question #11
Disadvantages of managed care include all of the following EXCEPT:
A.
It includes disease management programs based on recent research.
B.
It may require physicians to carry additional malpractice insurance.
C.
It creates an increased administrative burden.
D.
It restricts physicians' latitude in caring for patients.
Question #12
The type of insurance coverage that provides protection against a specific type of accident or illness is:
A.
catastrophic health insurance.
B.
special risk.
C.
outpatient.
D.
major medical.
Question #13
The type of insurance that provides coverage for a designated period of time is:
A.
long-term care.
B.
short-term health insurance.
C.
special risk.
D.
medical insurance.
Question #14
Providers who contract with managed care organizations (MCOs) must provide care according to the MCO's policies and guidelines in order to:
A.
increase revenue.
B.
increase patient load.
C.
be listed in the provider directory.
D.
be paid for services provided.
Question #15
An insurance identification card usually includes all of the following information EXCEPT:
A.
detailed benefit information.
B.
name of the subscriber.
C.
insurance policy number.
D.
name of the insurance policy.
Question #16
Insurance information obtained by the medical office specialist:
A.
verified with the insurance company.
B.
All of these.
C.
updated on a regular basis.
D.
should be kept in the medical record.
Question #17
Which type of statement signed by the patient authorizes his or her insurance company to send payments directly to the provider?
A.
assignment of benefits
B.
advance directive
C.
authorization to release protected health information
D.
beneficiary designation
Question #18
A physician who coordinates a patient's care and refers patients to specialists is a(n):
A.
referring gatekeeper.
B.
primary physician coordinator (PPC).
C.
primary care physician (PCP).
D.
preferred provider physician (PPP).
Question #19
In 2011, the new health care reform law required insurers to offer dependent coverage for adult children up to age ________ so they could be included on their parents' coverage.
A.
18
B.
21
C.
26
D.
24
Question #20
The Patient Protection and Affordable Care Act requires that all individuals have health insurance beginning in:
A.
2015
B.
2013
C.
2014
D.
2012
Question #21
If a physician has ordered surgery for a patient, a managed care organization (MCO) case manager may disallow an inpatient stay if the MCO guidelines designate the procedure as best suited for outpatient care.
A.
TRUE
B.
FALSE
Question #22
The restrictions in a health maintenance organization (HMO) reduce members' premium costs.
A.
TRUE
B.
FALSE
Need help with your exam preparation?
Get Answers to this exam for $6 USD.
Get Answers to all exams in [ MOA 183 - Medical Billing and Coding ] course for $25 USD.
Existing Quiz Clients Login here