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.
usual.
B.
ordinary.
C.
reasonable.
D.
customary.
Question #2
Utilization guidelines are used to:
A.
determine if the provider is in the network.
B.
determine if services are medically necessary.
C.
determine if care is provided by the most appropriate provider.
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.
EPO plan
B.
HMO plan
C.
Indemnity plan
D.
PPO plan
Question #4
All the following are true regarding HMOs EXCEPT:
A.
encourage preventative health services.
B.
require a referral for specialist services.
C.
regulated by federal and state law.
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.
$2,000
B.
$250
C.
$500
D.
$1,000
Question #6
The most restrictive type of managed care plan is the:
A.
exclusive provider organization (EPO).
B.
preferred provider organization (PPO).
C.
individual practice association (IPA).
D.
health maintenance organization (HMO).
Question #7
All of the following are government plans under the Affordable Care Act EXCEPT:
A.
silver.
B.
titanium
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.
staff model.
B.
network model.
C.
group model.
D.
individual practice association (IPA) 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.
staff model.
C.
group model.
D.
network 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.
staff model.
C.
group model.
D.
individual practice association (IPA) model.
Question #11
Disadvantages of managed care include all of the following EXCEPT:
A.
It may require physicians to carry additional malpractice insurance.
B.
It includes disease management programs based on recent research.
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.
outpatient.
B.
major medical.
C.
catastrophic health insurance.
D.
special risk.
Question #13
The type of insurance that provides coverage for a designated period of time is:
A.
special risk.
B.
medical insurance.
C.
short-term health insurance.
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.
detailed benefit information.
B.
name of the subscriber.
C.
name of the insurance policy.
D.
insurance policy number.
Question #16
Insurance information obtained by the medical office specialist:
A.
updated on a regular basis.
B.
should be kept in the medical record.
C.
verified with the insurance company.
D.
All of these.
Question #17
Which type of statement signed by the patient authorizes his or her insurance company to send payments directly to the provider?
A.
beneficiary designation
B.
authorization to release protected health information
C.
assignment of benefits
D.
advance directive
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.
preferred provider physician (PPP).
D.
primary care physician (PCP).
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.
21
B.
26
C.
24
D.
18
Question #20
The Patient Protection and Affordable Care Act requires that all individuals have health insurance beginning in:
A.
2014
B.
2015
C.
2013
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.
FALSE
B.
TRUE
Question #22
The restrictions in a health maintenance organization (HMO) reduce members' premium costs.
A.
FALSE
B.
TRUE
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