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.
refused to extend health insurance to employees.
C.
increased employee premium contributions.
D.
hired younger 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.
provider networks and discounted fees for services.
C.
discounted fees for services and mandatory high deductibles across all health plans.
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.
adjusted amount.
B.
allowed amount.
C.
diagnostic code.
D.
billed amount.
Question #4
In a managed care organization (MCO), a primary care physician (PCP) is any of the following EXCEPT:
A.
general practitioner.
B.
dermatologist.
C.
family practitioner.
D.
internal medicine doctor.
Question #5
The duties of a primary care physician (PCP) in a health maintenance organization (HMO) include:
A.
All of these.
B.
acting as a gatekeeper to services.
C.
referring patients to specialists.
D.
coordinating patient care.
Question #6
The subscriber in a health maintenance organization (HMO) can also be called a(n):
A.
patient or carrier.
B.
employer or policyholder.
C.
member or provider.
D.
policyholder or member.
Question #7
Which is true regarding health reimbursement arrangements (HRAs)?
A.
participation ends upon termination of employment.
B.
expenses must have incurred during the coverage period.
C.
the funds cannot be used for dental and vision care.
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.
enroll more members in the health plan.
B.
minimize malpractice suits.
C.
maintain their income.
D.
deliver MCO-required preventive care.
Question #9
All of the following are types of health maintenance organizations (HMOs) EXCEPT the:
A.
open access model.
B.
preferred provider model.
C.
individual practice association.
D.
group 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.
It includes a contracted network of providers.
B.
The plan is more restrictive than a health maintenance organization (HMO).
C.
Members must obtain referrals to see a specialist.
D.
Members select a primary care physician (PCP) as a gatekeeper.
Question #12
Advantages of managed care include all of the following EXCEPT:
A.
Providers strive to improve the quality of their care.
B.
Hospitals and physicians provide services more efficiently.
C.
Physicians run the risk of unfavorable evaluations by enrollees.
D.
Data is collected and analyzed to measure health outcomes.
Question #13
An exclusive provider organization (EPO) is similar to a preferred provider organization (PPO) because they both have:
A.
payment by capitation.
B.
a flexible benefit design.
C.
gatekeepers.
D.
a limited provider network.
Question #14
Physician-hospital organizations (PHOs) may include:
A.
surgery centers.
B.
All of these.
C.
nursing homes.
D.
laboratories.
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 children only.
D.
employees and spouses only
Question #16
The type of policy that would provide coverage for custodial care in a nursing home is:
A.
major medical insurance.
B.
short-term health insurance.
C.
special risk 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.
account manager or business manager.
C.
medical office specialist.
D.
attorney.
Question #18
A provider who enters into a contract with an MCO is referred to as a(n):
A.
MCO provider.
B.
participating provider.
C.
active provider.
D.
permanent 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 how the physician will be paid for services.
D.
description of what types of employer groups are offered coverage.
Question #20
Under a discounted fee-for-service arrangement, covered services are compensated at a:
A.
reduced per-case rate.
B.
reduced percentage of usual and customary charges.
C.
per-member-per-month rate.
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.
charge the usual and customary fee instead of the discounted fee.
B.
bill the patient directly.
C.
take legal action against the MCO.
D.
terminate the MCO contract after filing a written notice of intention.
Question #22
In plans that require the primary care physician (PCP) to play a gatekeeper role, the PCP is given incentives to:
A.
see as many patients each day as possible, even if this means less time with each patient.
B.
make frequent referrals to contracted network specialists.
C.
expand office hours and/or staff to permit more patients to be seen each day.
D.
treat the patient as much as possible without a specialist referral unless absolutely necessary.
Question #23
In MCOs, the business aspects of healthcare are not being controlled by:
A.
actuaries.
B.
managers.
C.
accountants.
D.
physicians.
Question #24
A managed care organization (MCO) uses a credentialing process to evaluate a provider's:
A.
service fees.
B.
medical credentials.
C.
All of these.
D.
workplace environment.
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.
26
B.
19
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.
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.
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.
eligibility requests and verifications
B.
claim status requests and reports
C.
All of these
D.
health insurance claims
Question #34
The document used to authorize permission for the release of protected health information (PHI) is the:
A.
designation of beneficiary form.
B.
designation for release of medical information 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.
The U.S. Food and Drug Administration requests it in relation to a product recall.
B.
An organ procurement organization requests it to facilitate the donation and transplantation of organs.
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.
file a complaint about how long it takes to get a claim paid.
C.
at least 10 free copies.
D.
request corrections of any inaccuracies in the records.
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.
Centers for Medicare and Medicaid Services (CMS).
C.
individuals whose records were affected.
D.
Consumer Protection Agency.
Question #38
Approximately how many different formats are currently being used for electronic health claims?
A.
400
B.
450
C.
500
D.
350
Question #39
HIPAA requires that diagnoses and services be reported in a standard, consistent manner; this is accomplished by using uniform:
A.
code sets.
B.
descriptors.
C.
modifiers.
D.
claim forms.
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.
administrative, physical, and electronic.
C.
physical, administrative, and technical.
D.
physical, technical, and procedural.
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.
$100,000
D.
$150,000
Question #42
The HITECH Act expands the privacy provisions of HIPAA to include:
A.
friends and family of providers.
B.
corporate owners of covered entities.
C.
business associates of covered entities.
D.
friends and family of patients.
Question #43
Healthcare providers who achieve the standards of each HITECH stage by a designated date are eligible for:
A.
Medicare and Medicaid incentive payments.
B.
Medicaid incentive payments.
C.
free license renewals as long as they remain in practice.
D.
Medicare incentive payments.
Question #44
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
The Omnibus Rule requires standards for the disclosure and use of protected health information (PHI), including established standards of enforcement for penalties and breach notification.
A.
TRUE
B.
FALSE
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