MOA 183 - Medical Billing and Coding » Fall 2020 » Exam 1
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Question #1
To avoid the higher costs of healthcare, employers:
A.
decreased the number of health plans available to employees.
B.
hired younger employees.
C.
increased employee premium contributions.
D.
refused to extend health insurance to employees.
Question #2
Managed care systems ensure the delivery of high-quality care while managing costs through:
A.
provider networks and regular premium increases.
B.
discounted fees for services and mandatory high deductibles across all health plans.
C.
prohibiting the use of out-of-network providers.
D.
provider networks and discounted fees for services.
Question #3
To determine the amount due from a patient, it is necessary to know the:
A.
allowed amount.
B.
adjusted amount.
C.
billed amount.
D.
diagnostic code.
Question #4
In a managed care organization (MCO), a primary care physician (PCP) is any of the following EXCEPT:
A.
internal medicine doctor.
B.
family practitioner.
C.
general practitioner.
D.
dermatologist.
Question #5
The duties of a primary care physician (PCP) in a health maintenance organization (HMO) include:
A.
All of these.
B.
coordinating patient care.
C.
referring patients to specialists.
D.
acting as a gatekeeper to services.
Question #6
The subscriber in a health maintenance organization (HMO) can also be called a(n):
A.
patient or carrier.
B.
policyholder or member.
C.
member or provider.
D.
employer or policyholder.
Question #7
Which is true regarding health reimbursement arrangements (HRAs)?
A.
the funds cannot be used for dental and vision care.
B.
expenses must have incurred during the coverage period.
C.
participation ends upon termination of employment.
D.
unused reimbursements cannot be accessed.
Question #8
By accepting lower payments from MCOs, physicians are forced to see more patients each day in order to:
A.
deliver MCO-required preventive care.
B.
minimize malpractice suits.
C.
enroll more members in the health plan.
D.
maintain their income.
Question #9
All of the following are types of health maintenance organizations (HMOs) EXCEPT the:
A.
open access model.
B.
individual practice association.
C.
group model.
D.
preferred provider model.
Question #10
All the following are true regarding the Affordable Care Act EXCEPT:
A.
It requires people to prove citizenship before receiving services.
B.
It cannot deny coverage due to a pre-existing condition.
C.
It is also known as Obamacare.
D.
It offers five different types of government plans.
Question #11
Which of the following is a characteristic of a preferred provider organization (PPO)?
A.
Members select a primary care physician (PCP) as a gatekeeper.
B.
It includes a contracted network of providers.
C.
Members must obtain referrals to see a specialist.
D.
The plan is more restrictive than a health maintenance organization (HMO).
Question #12
Advantages of managed care include all of the following EXCEPT:
A.
Data is collected and analyzed to measure health outcomes.
B.
Physicians run the risk of unfavorable evaluations by enrollees.
C.
Providers strive to improve the quality of their care.
D.
Hospitals and physicians provide services more efficiently.
Question #13
An exclusive provider organization (EPO) is similar to a preferred provider organization (PPO) because they both have:
A.
payment by capitation.
B.
gatekeepers.
C.
a flexible benefit design.
D.
a limited provider network.
Question #14
Physician-hospital organizations (PHOs) may include:
A.
surgery centers.
B.
nursing homes.
C.
laboratories.
D.
All of these.
Question #15
Group insurance is issued to an employer to provide coverage for:
A.
employees and all their dependents.
B.
employees only.
C.
employees and spouses only
D.
employees and children only.
Question #16
The type of policy that would provide coverage for custodial care in a nursing home is:
A.
short-term health insurance.
B.
special risk insurance.
C.
major medical insurance.
D.
long-term care insurance.
Question #17
Contracts between the physician and managed care organization (MCO) are generally negotiated by the:
A.
physician or upper management.
B.
attorney.
C.
account manager or business manager.
D.
medical office specialist.
Question #18
A provider who enters into a contract with an MCO is referred to as a(n):
A.
MCO provider.
B.
active provider.
C.
permanent provider.
D.
participating provider.
Question #19
A managed care contract will include a:
A.
description of how the physician will be paid for services.
B.
description of what types of employer groups are offered coverage.
C.
list of patients covered by the plan.
D.
list of physicians in the network.
Question #20
Under a discounted fee-for-service arrangement, covered services are compensated at a:
A.
reduced per-case rate.
B.
per-member-per-month rate.
C.
reduced percentage of usual and customary charges.
D.
discounted per-diem rate.
Question #21
According to some contract terms, if an MCO does not pay a claim within the time limit specified in the contract, the provider may be able to:
A.
terminate the MCO contract after filing a written notice of intention.
B.
charge the usual and customary fee instead of the discounted fee.
C.
take legal action against the MCO.
D.
bill the patient directly.
Question #22
In plans that require the primary care physician (PCP) to play a gatekeeper role, the PCP is given incentives to:
A.
expand office hours and/or staff to permit more patients to be seen each day.
B.
treat the patient as much as possible without a specialist referral unless absolutely necessary.
C.
make frequent referrals to contracted network specialists.
D.
see as many patients each day as possible, even if this means less time with each patient.
Question #23
In MCOs, the business aspects of healthcare are not being controlled by:
A.
managers.
B.
physicians.
C.
accountants.
D.
actuaries.
Question #24
A managed care organization (MCO) uses a credentialing process to evaluate a provider's:
A.
All of these.
B.
medical credentials.
C.
service fees.
D.
workplace environment.
Question #25
With respect to National Committee for Quality Assurance (NCQA) accreditation:
A.
MCOs must be accredited to operate.
B.
MCOs have all asked to be accredited, but some do not qualify.
C.
accredited MCOs are always better than nonaccredited MCOs.
D.
some MCOs are accredited, and some are not.
Question #26
In the Patient's Bill of Rights under the Affordable Health Care Act, young adults who are not offered coverage at work are covered by their parents' plan until they reach:
A.
21
B.
19
C.
26
D.
25
Question #27
Types of payment arrangements in managed care contracts include discounted fee-for-service, per diem, per case, percentage of premiums, and capitation.
A.
TRUE
B.
FALSE
Question #28
ACOs are a group of insurance providers.
A.
TRUE
B.
FALSE
Question #29
Most managed care contracts allow an unlimited time frame for submitting claims.
A.
FALSE
B.
TRUE
Question #30
In order to receive National Committee for Quality Assurance (NCQA) accreditation, a managed care organization (MCO) must demonstrate that it has a thorough credentialing process.
A.
TRUE
B.
FALSE
Question #31
Patients are typically very familiar with their health plan benefits when discussing claims issues with the medical office specialist.
A.
TRUE
B.
FALSE
Question #32
A managed care organization will contract with physicians, laboratories, pharmacies, hospitals, clinics, and other healthcare facilities in building a provider network.
A.
FALSE
B.
TRUE
Question #33
HIPAA guidelines apply to which of the following types of healthcare administrative transactions?
A.
claim status requests and reports
B.
eligibility requests and verifications
C.
health insurance claims
D.
All of these
Question #34
The document used to authorize permission for the release of protected health information (PHI) is the:
A.
designation for release of medical information form.
B.
designation of beneficiary form.
C.
assignment of benefits form.
D.
acknowledgment of informed consent form.
Question #35
Protected health information (PHI) can be disclosed in which of the following circumstances?
A.
An organ procurement organization requests it to facilitate the donation and transplantation of organs.
B.
All of these
C.
The U.S. Food and Drug Administration requests it in relation to a product recall.
D.
A coroner requests it to assist in identifying a body.
Question #36
HIPAA guidelines grant patients the right to access their own medical records and the right to:
A.
request corrections of any inaccuracies in the records.
B.
designate a specific person at an insurance company who may also have access.
C.
at least 10 free copies.
D.
file a complaint about how long it takes to get a claim paid.
Question #37
In the event of a security breach in regard to protected health information (PHI), providers and other covered entities must notify both the Office for Civil Rights (OCR) and the:
A.
Consumer Protection Agency.
B.
individuals whose records were affected.
C.
insurance carriers whose claims were affected.
D.
Centers for Medicare and Medicaid Services (CMS).
Question #38
Approximately how many different formats are currently being used for electronic health claims?
A.
500
B.
400
C.
450
D.
350
Question #39
HIPAA requires that diagnoses and services be reported in a standard, consistent manner; this is accomplished by using uniform:
A.
claim forms.
B.
modifiers.
C.
descriptors.
D.
code sets.
Question #40
The three types of safeguards that must be in place to be in compliance with the HIPAA Security Rule are:
A.
technical, training, and administrative.
B.
physical, technical, and procedural.
C.
physical, administrative, and technical.
D.
administrative, physical, and electronic.
Question #41
Criminal penalties for HIPAA violations can include prison time and financial penalties up to what maximum amount?
A.
$250,000
B.
$400,000
C.
$150,000
D.
$100,000
Question #42
The HITECH Act expands the privacy provisions of HIPAA to include:
A.
business associates of covered entities.
B.
friends and family of patients.
C.
corporate owners of covered entities.
D.
friends and family of providers.
Question #43
Healthcare providers who achieve the standards of each HITECH stage by a designated date are eligible for:
A.
Medicaid incentive payments.
B.
Medicare incentive payments.
C.
free license renewals as long as they remain in practice.
D.
Medicare and Medicaid incentive payments.
Question #44
A healthcare provider is not allowed to discuss a patient's medical condition or payment with a person over the phone.
A.
FALSE
B.
TRUE
Question #45
When patients ask a family member to remain with them in a treatment room, this implies that they have given permission for the doctor and/or staff to discuss their condition in front of the family member.
A.
TRUE
B.
FALSE
Question #46
Patients have the right to access and copy their medical records, but they cannot dispute anything in the record.
A.
TRUE
B.
FALSE
Question #47
A.
FALSE
B.
TRUE
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