MOA 183 - Medical Billing and Coding » Fall 2020 » Chapter 2 Quiz
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Question #1
Terms that refer to fees in an insurance contract include all of the following EXCEPT:
A.
customary.
B.
reasonable.
C.
usual.
D.
ordinary.
Question #2
Utilization guidelines are used to:
A.
determine if care is provided by the most appropriate provider.
B.
determine if services are medically necessary.
C.
determine if the provider is in the network.
D.
determine if an employee is covered under the plan.
Question #3
Which of the following plan types does not use a network of providers?
A.
Indemnity plan
B.
EPO plan
C.
PPO plan
D.
HMO plan
Question #4
All the following are true regarding HMOs EXCEPT:
A.
regulated by federal and state law.
B.
require a referral for specialist services.
C.
encourage preventative health services.
D.
the least restrictive type of care plan.
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.
$250
B.
$2,000
C.
$1,000
D.
$500
Question #6
The most restrictive type of managed care plan is the:
A.
exclusive provider organization (EPO).
B.
health maintenance organization (HMO).
C.
individual practice association (IPA).
D.
preferred provider organization (PPO).
Question #7
All of the following are government plans under the Affordable Care Act EXCEPT:
A.
catastrophic.
B.
titanium
C.
silver.
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.
individual practice association (IPA) model.
B.
network model.
C.
group 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.
network model.
B.
individual practice association (IPA) model.
C.
staff model.
D.
group 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.
network model.
C.
staff model.
D.
individual practice association (IPA) model.
Question #11
Disadvantages of managed care include all of the following EXCEPT:
A.
It restricts physicians' latitude in caring for patients.
B.
It includes disease management programs based on recent research.
C.
It creates an increased administrative burden.
D.
It may require physicians to carry additional malpractice insurance.
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.
major medical.
D.
outpatient.
Question #13
The type of insurance that provides coverage for a designated period of time is:
A.
short-term health insurance.
B.
medical insurance.
C.
special risk.
D.
long-term care.
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.
be paid for services provided.
B.
be listed in the provider directory.
C.
increase patient load.
D.
increase revenue.
Question #15
An insurance identification card usually includes all of the following information EXCEPT:
A.
insurance policy number.
B.
detailed benefit information.
C.
name of the subscriber.
D.
name of the insurance policy.
Question #16
Insurance information obtained by the medical office specialist:
A.
updated on a regular basis.
B.
verified with the insurance company.
C.
All of these.
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.
authorization to release protected health information
B.
advance directive
C.
assignment of benefits
D.
beneficiary designation
Question #18
A physician who coordinates a patient's care and refers patients to specialists is a(n):
A.
primary physician coordinator (PPC).
B.
referring gatekeeper.
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.
24
C.
26
D.
21
Question #20
The Patient Protection and Affordable Care Act requires that all individuals have health insurance beginning in:
A.
2015
B.
2014
C.
2012
D.
2013
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.
FALSE
B.
TRUE
Question #22
The restrictions in a health maintenance organization (HMO) reduce members' premium costs.
A.
TRUE
B.
FALSE
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