Glendale Community College » Medical Office Administration » MOA 183 - Medical Billing and Coding » Fall 2020

MOA 183 - Medical Billing and Coding » Fall 2020 » Exam 1

Need help with your exam preparation?

Existing Quiz Clients Login here

Question #1

To avoid the higher costs of healthcare, employers:

A. hired younger employees.

B. increased employee premium contributions.

C. decreased the number of health plans available to 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. prohibiting the use of out-of-network providers.

B. provider networks and discounted fees for services.

C. discounted fees for services and mandatory high deductibles across all health plans.

D. provider networks and regular premium increases.

Question #3

To determine the amount due from a patient, it is necessary to know the:

A. billed amount.

B. adjusted amount.

C. diagnostic code.

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. All of these.

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. policyholder or member.

B. member or provider.

C. employer or policyholder.

D. patient or carrier.

Question #7

Which is true regarding health reimbursement arrangements (HRAs)?

A. unused reimbursements cannot be accessed.

B. expenses must have incurred during the coverage period.

C. the funds cannot be used for dental and vision care.

D. participation ends upon termination of employment.

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. maintain their income.

C. deliver MCO-required preventive care.

D. minimize malpractice suits.

Question #9

All of the following are types of health maintenance organizations (HMOs) EXCEPT the:

A. open access model.

B. individual practice association.

C. preferred provider model.

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 is also known as Obamacare.

C. It cannot deny coverage due to a pre-existing condition.

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 must obtain referrals to see a specialist.

B. The plan is more restrictive than a health maintenance organization (HMO).

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. Data is collected and analyzed to measure health outcomes.

C. Physicians run the risk of unfavorable evaluations by enrollees.

D. Providers strive to improve the quality of their care.

Question #13

An exclusive provider organization (EPO) is similar to a preferred provider organization (PPO) because they both have:

A. gatekeepers.

B. payment by capitation.

C. a flexible benefit design.

D. a limited provider network.

Question #14

Physician-hospital organizations (PHOs) may include:

A. nursing homes.

B. surgery centers.

C. All of these.

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. long-term care insurance.

B. major medical insurance.

C. short-term health insurance.

D. special risk insurance.

Question #17

Contracts between the physician and managed care organization (MCO) are generally negotiated by the:

A. attorney.

B. account manager or business manager.

C. physician or upper management.

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. participating provider.

C. permanent provider.

D. active provider.

Question #19

A managed care contract will include a:

A. list of patients covered by the plan.

B. list of physicians in the network.

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 percentage of usual and customary charges.

B. reduced per-case rate.

C. discounted per-diem rate.

D. per-member-per-month 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. take legal action against the MCO.

B. terminate the MCO contract after filing a written notice of intention.

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. treat the patient as much as possible without a specialist referral unless absolutely necessary.

B. expand office hours and/or staff to permit more patients to be seen each day.

C. see as many patients each day as possible, even if this means less time with each patient.

D. make frequent referrals to contracted network specialists.

Question #23

In MCOs, the business aspects of healthcare are not being controlled by:

A. accountants.

B. physicians.

C. managers.

D. actuaries.

Question #24

A managed care organization (MCO) uses a credentialing process to evaluate a provider's:

A. All of these.

B. service fees.

C. medical credentials.

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. 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. TRUE

B. FALSE

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. 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. 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. TRUE

B. FALSE

Question #33

HIPAA guidelines apply to which of the following types of healthcare administrative transactions?

A. All of these

B. health insurance claims

C. claim status requests and reports

D. eligibility requests and verifications

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. designation for release of medical information form.

C. assignment of benefits form.

D. designation of beneficiary 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

A. designate a specific person at an insurance company who may also have access.

B. request corrections of any inaccuracies in the records.

C. file a complaint about how long it takes to get a claim paid.

D. at least 10 free copies.

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. Consumer Protection Agency.

D. individuals whose records were affected.

Question #38

Approximately how many different formats are currently being used for electronic health claims?

A. 350

B. 450

C. 500

D. 400

Question #39

HIPAA requires that diagnoses and services be reported in a standard, consistent manner; this is accomplished by using uniform:

A. modifiers.

B. code sets.

C. descriptors.

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. administrative, physical, and electronic.

B. technical, training, and administrative.

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. $400,000

B. $100,000

C. $150,000

D. $250,000

Question #42

The HITECH Act expands the privacy provisions of HIPAA to include:

A. business associates of covered entities.

B. corporate owners of covered entities.

C. friends and family of providers.

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 incentive payments.

B. free license renewals as long as they remain in practice.

C. Medicare and Medicaid incentive payments.

D. 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. 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. TRUE

B. FALSE

Question #47

A. TRUE

B. FALSE

Need help with your exam preparation?

Existing Quiz Clients Login here