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.
ordinary.
C.
reasonable.
D.
usual.
Question #2
Utilization guidelines are used to:
A.
determine if care is provided by the most appropriate provider.
B.
determine if the provider is in the network.
C.
determine if an employee is covered under the plan.
D.
determine if services are medically necessary.
Question #3
Which of the following plan types does not use a network of providers?
A.
HMO plan
B.
Indemnity plan
C.
EPO plan
D.
PPO plan
Question #4
All the following are true regarding HMOs EXCEPT:
A.
require a referral for specialist services.
B.
regulated by federal and state law.
C.
the least restrictive type of care plan.
D.
encourage preventative health 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.
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.
bronze.
B.
catastrophic.
C.
silver.
D.
titanium
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.
staff model.
C.
network model.
D.
group 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.
individual practice association (IPA) model.
B.
network 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.
network model.
B.
group model.
C.
staff model.
D.
individual practice association (IPA) model.
Question #11
Disadvantages of managed care include all of the following EXCEPT:
A.
It creates an increased administrative burden.
B.
It includes disease management programs based on recent research.
C.
It may require physicians to carry additional malpractice insurance.
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.
special risk.
B.
long-term care.
C.
medical insurance.
D.
short-term health 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.
be paid for services provided.
B.
increase patient load.
C.
be listed in the provider directory.
D.
increase revenue.
Question #15
An insurance identification card usually includes all of the following information EXCEPT:
A.
insurance policy number.
B.
name of the insurance policy.
C.
detailed benefit information.
D.
name of the subscriber.
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.
authorization to release protected health information
B.
advance directive
C.
beneficiary designation
D.
assignment of benefits
Question #18
A physician who coordinates a patient's care and refers patients to specialists is a(n):
A.
primary physician coordinator (PPC).
B.
primary care physician (PCP).
C.
preferred provider physician (PPP).
D.
referring gatekeeper.
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.
26
B.
18
C.
24
D.
21
Question #20
The Patient Protection and Affordable Care Act requires that all individuals have health insurance beginning in:
A.
2013
B.
2015
C.
2012
D.
2014
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
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