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.
customary.
D.
reasonable.
Question #2
Utilization guidelines are used to:
A.
determine if services are medically necessary.
B.
determine if an employee is covered under the plan.
C.
determine if care is provided by the most appropriate provider.
D.
determine if the provider is in the network.
Question #3
Which of the following plan types does not use a network of providers?
A.
HMO plan
B.
EPO plan
C.
PPO plan
D.
Indemnity plan
Question #4
All the following are true regarding HMOs EXCEPT:
A.
require a referral for specialist services.
B.
encourage preventative health services.
C.
the least restrictive type of care plan.
D.
regulated by federal and state law.
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.
$1,000
B.
$500
C.
$250
D.
$2,000
Question #6
The most restrictive type of managed care plan is the:
A.
individual practice association (IPA).
B.
preferred provider organization (PPO).
C.
health maintenance organization (HMO).
D.
exclusive provider organization (EPO).
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.
staff model.
B.
group model.
C.
network 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.
staff model.
B.
group model.
C.
individual practice association (IPA) 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.
individual practice association (IPA) model.
B.
group model.
C.
network model.
D.
staff 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.
major medical.
B.
special risk.
C.
outpatient.
D.
catastrophic health insurance.
Question #13
The type of insurance that provides coverage for a designated period of time is:
A.
medical insurance.
B.
long-term care.
C.
special risk.
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.
be listed in the provider directory.
C.
increase revenue.
D.
increase patient load.
Question #15
An insurance identification card usually includes all of the following information EXCEPT:
A.
name of the subscriber.
B.
name of the insurance policy.
C.
insurance policy number.
D.
detailed benefit information.
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.
advance directive
B.
assignment of benefits
C.
beneficiary designation
D.
authorization to release protected health information
Question #18
A physician who coordinates a patient's care and refers patients to specialists is a(n):
A.
primary care physician (PCP).
B.
primary physician coordinator (PPC).
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.
21
B.
24
C.
18
D.
26
Question #20
The Patient Protection and Affordable Care Act requires that all individuals have health insurance beginning in:
A.
2014
B.
2013
C.
2015
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
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