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.
increased employee premium contributions.
C.
hired younger employees.
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.
discounted fees for services and mandatory high deductibles across all health plans.
B.
provider networks and regular premium increases.
C.
provider networks and discounted fees for services.
D.
prohibiting the use of out-of-network providers.
Question #3
To determine the amount due from a patient, it is necessary to know the:
A.
diagnostic code.
B.
billed amount.
C.
adjusted amount.
D.
allowed amount.
Question #4
In a managed care organization (MCO), a primary care physician (PCP) is any of the following EXCEPT:
A.
dermatologist.
B.
internal medicine doctor.
C.
family practitioner.
D.
general practitioner.
Question #5
The duties of a primary care physician (PCP) in a health maintenance organization (HMO) include:
A.
acting as a gatekeeper to services.
B.
referring patients to specialists.
C.
coordinating patient care.
D.
All of these.
Question #6
The subscriber in a health maintenance organization (HMO) can also be called a(n):
A.
member or provider.
B.
employer or policyholder.
C.
policyholder or member.
D.
patient or carrier.
Question #7
Which is true regarding health reimbursement arrangements (HRAs)?
A.
unused reimbursements cannot be accessed.
B.
participation ends upon termination of employment.
C.
expenses must have incurred during the coverage period.
D.
the funds cannot be used for dental and vision care.
Question #8
By accepting lower payments from MCOs, physicians are forced to see more patients each day in order to:
A.
minimize malpractice suits.
B.
deliver MCO-required preventive care.
C.
maintain their income.
D.
enroll more members in the health plan.
Question #9
All of the following are types of health maintenance organizations (HMOs) EXCEPT the:
A.
preferred provider model.
B.
group model.
C.
open access model.
D.
individual practice association.
Question #10
All the following are true regarding the Affordable Care Act EXCEPT:
A.
It cannot deny coverage due to a pre-existing condition.
B.
It requires people to prove citizenship before receiving services.
C.
It offers five different types of government plans.
D.
It is also known as Obamacare.
Question #11
Which of the following is a characteristic of a preferred provider organization (PPO)?
A.
The plan is more restrictive than a health maintenance organization (HMO).
B.
Members must obtain referrals to see a specialist.
C.
Members select a primary care physician (PCP) as a gatekeeper.
D.
It includes a contracted network of providers.
Question #12
Advantages of managed care include all of the following EXCEPT:
A.
Hospitals and physicians provide services more efficiently.
B.
Providers strive to improve the quality of their care.
C.
Data is collected and analyzed to measure health outcomes.
D.
Physicians run the risk of unfavorable evaluations by enrollees.
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 limited provider network.
D.
a flexible benefit design.
Question #14
Physician-hospital organizations (PHOs) may include:
A.
All of these.
B.
laboratories.
C.
surgery centers.
D.
nursing homes.
Question #15
Group insurance is issued to an employer to provide coverage for:
A.
employees only.
B.
employees and all their dependents.
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.
major medical insurance.
B.
long-term care insurance.
C.
special risk insurance.
D.
short-term health insurance.
Question #17
Contracts between the physician and managed care organization (MCO) are generally negotiated by the:
A.
physician or upper management.
B.
medical office specialist.
C.
account manager or business manager.
D.
attorney.
Question #18
A provider who enters into a contract with an MCO is referred to as a(n):
A.
participating provider.
B.
permanent provider.
C.
active provider.
D.
MCO provider.
Question #19
A managed care contract will include a:
A.
list of physicians in the network.
B.
list of patients covered by the plan.
C.
description of what types of employer groups are offered coverage.
D.
description of how the physician will be paid for services.
Question #20
Under a discounted fee-for-service arrangement, covered services are compensated at a:
A.
discounted per-diem rate.
B.
reduced per-case rate.
C.
per-member-per-month rate.
D.
reduced percentage of usual and customary charges.
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.
take legal action against the MCO.
C.
bill the patient directly.
D.
charge the usual and customary fee instead of the discounted fee.
Question #22
In plans that require the primary care physician (PCP) to play a gatekeeper role, the PCP is given incentives to:
A.
make frequent referrals to contracted network specialists.
B.
treat the patient as much as possible without a specialist referral unless absolutely necessary.
C.
expand office hours and/or staff to permit more patients to be seen each day.
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.
actuaries.
B.
physicians.
C.
managers.
D.
accountants.
Question #24
A managed care organization (MCO) uses a credentialing process to evaluate a provider's:
A.
service fees.
B.
workplace environment.
C.
All of these.
D.
medical credentials.
Question #25
With respect to National Committee for Quality Assurance (NCQA) accreditation:
A.
MCOs have all asked to be accredited, but some do not qualify.
B.
some MCOs are accredited, and some are not.
C.
accredited MCOs are always better than nonaccredited MCOs.
D.
MCOs must be accredited to operate.
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.
19
B.
26
C.
25
D.
21
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.
FALSE
B.
TRUE
Question #28
ACOs are a group of insurance providers.
A.
FALSE
B.
TRUE
Question #29
Most managed care contracts allow an unlimited time frame for submitting claims.
A.
TRUE
B.
FALSE
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.
FALSE
B.
TRUE
Question #31
Patients are typically very familiar with their health plan benefits when discussing claims issues with the medical office specialist.
A.
FALSE
B.
TRUE
Question #32
A managed care organization will contract with physicians, laboratories, pharmacies, hospitals, clinics, and other healthcare facilities in building a provider network.
A.
TRUE
B.
FALSE
Question #33
HIPAA guidelines apply to which of the following types of healthcare administrative transactions?
A.
All of these
B.
eligibility requests and verifications
C.
claim status requests and reports
D.
health insurance claims
Question #34
The document used to authorize permission for the release of protected health information (PHI) is the:
A.
acknowledgment of informed consent form.
B.
assignment of benefits form.
C.
designation of beneficiary form.
D.
designation for release of medical information 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.
The U.S. Food and Drug Administration requests it in relation to a product recall.
C.
A coroner requests it to assist in identifying a body.
D.
All of these
Question #36
HIPAA guidelines grant patients the right to access their own medical records and the right to:
A.
designate a specific person at an insurance company who may also have access.
B.
request corrections of any inaccuracies in the records.
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.
insurance carriers whose claims were affected.
B.
Consumer Protection Agency.
C.
Centers for Medicare and Medicaid Services (CMS).
D.
individuals whose records were affected.
Question #38
Approximately how many different formats are currently being used for electronic health claims?
A.
450
B.
500
C.
400
D.
350
Question #39
HIPAA requires that diagnoses and services be reported in a standard, consistent manner; this is accomplished by using uniform:
A.
modifiers.
B.
descriptors.
C.
claim forms.
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.
$400,000
B.
$150,000
C.
$250,000
D.
$100,000
Question #42
The HITECH Act expands the privacy provisions of HIPAA to include:
A.
friends and family of providers.
B.
friends and family of patients.
C.
business associates of covered entities.
D.
corporate owners of covered entities.
Question #43
Healthcare providers who achieve the standards of each HITECH stage by a designated date are eligible for:
A.
Medicare incentive payments.
B.
free license renewals as long as they remain in practice.
C.
Medicaid incentive payments.
D.
Medicare and Medicaid incentive payments.
Question #44
A.
TRUE
B.
FALSE
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.
FALSE
B.
TRUE
Question #46
Patients have the right to access and copy their medical records, but they cannot dispute anything in the record.
A.
FALSE
B.
TRUE
Question #47
A.
FALSE
B.
TRUE
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