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.
hired younger employees.
B.
increased employee premium contributions.
C.
refused to extend health insurance to employees.
D.
decreased the number of health plans available 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.
prohibiting the use of out-of-network providers.
C.
provider networks and discounted fees for services.
D.
discounted fees for services and mandatory high deductibles across all health plans.
Question #3
To determine the amount due from a patient, it is necessary to know the:
A.
diagnostic code.
B.
allowed amount.
C.
adjusted amount.
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.
referring patients to specialists.
B.
acting as a gatekeeper to services.
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.
employer or policyholder.
B.
patient or carrier.
C.
policyholder or member.
D.
member or provider.
Question #7
Which is true regarding health reimbursement arrangements (HRAs)?
A.
the funds cannot be used for dental and vision care.
B.
participation ends upon termination of employment.
C.
unused reimbursements cannot be accessed.
D.
expenses must have incurred during the coverage period.
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.
maintain their income.
C.
deliver MCO-required preventive care.
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.
individual practice association.
C.
open access model.
D.
group model.
Question #10
All the following are true regarding the Affordable Care Act EXCEPT:
A.
It offers five different types of government plans.
B.
It is also known as Obamacare.
C.
It cannot deny coverage due to a pre-existing condition.
D.
It requires people to prove citizenship before receiving services.
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.
It includes a contracted network of providers.
C.
The plan is more restrictive than a health maintenance organization (HMO).
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.
Physicians run the risk of unfavorable evaluations by enrollees.
C.
Data is collected and analyzed to measure health outcomes.
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.
a flexible benefit design.
C.
a limited provider network.
D.
gatekeepers.
Question #14
Physician-hospital organizations (PHOs) may include:
A.
surgery centers.
B.
laboratories.
C.
All of these.
D.
nursing homes.
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 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.
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.
account manager or business manager.
B.
attorney.
C.
medical office specialist.
D.
physician or upper management.
Question #18
A provider who enters into a contract with an MCO is referred to as a(n):
A.
participating provider.
B.
MCO provider.
C.
active provider.
D.
permanent 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 physicians in the network.
D.
list of patients covered by the plan.
Question #20
Under a discounted fee-for-service arrangement, covered services are compensated at a:
A.
reduced percentage of usual and customary charges.
B.
discounted per-diem rate.
C.
reduced per-case 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.
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.
see as many patients each day as possible, even if this means less time with each patient.
B.
treat the patient as much as possible without a specialist referral unless absolutely necessary.
C.
make frequent referrals to contracted network specialists.
D.
expand office hours and/or staff to permit more patients to be seen each day.
Question #23
In MCOs, the business aspects of healthcare are not being controlled by:
A.
managers.
B.
accountants.
C.
actuaries.
D.
physicians.
Question #24
A managed care organization (MCO) uses a credentialing process to evaluate a provider's:
A.
service fees.
B.
All of these.
C.
workplace environment.
D.
medical credentials.
Question #25
With respect to National Committee for Quality Assurance (NCQA) accreditation:
A.
MCOs must be accredited to operate.
B.
accredited MCOs are always better than nonaccredited MCOs.
C.
MCOs have all asked to be accredited, but some do not qualify.
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.
TRUE
B.
FALSE
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.
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.
FALSE
B.
TRUE
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.
health insurance claims
D.
claim status requests and reports
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.
assignment of benefits form.
C.
acknowledgment of informed consent form.
D.
designation of beneficiary form.
Question #35
Protected health information (PHI) can be disclosed in which of the following circumstances?
A.
A coroner requests it to assist in identifying a body.
B.
An organ procurement organization requests it to facilitate the donation and transplantation of organs.
C.
All of these
D.
The U.S. Food and Drug Administration requests it in relation to a product recall.
Question #36
HIPAA guidelines grant patients the right to access their own medical records and the right to:
A.
file a complaint about how long it takes to get a claim paid.
B.
at least 10 free copies.
C.
request corrections of any inaccuracies in the records.
D.
designate a specific person at an insurance company who may also have access.
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.
500
C.
350
D.
450
Question #39
HIPAA requires that diagnoses and services be reported in a standard, consistent manner; this is accomplished by using uniform:
A.
descriptors.
B.
code sets.
C.
claim forms.
D.
modifiers.
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.
physical, technical, and procedural.
C.
technical, training, and administrative.
D.
physical, administrative, and technical.
Question #41
Criminal penalties for HIPAA violations can include prison time and financial penalties up to what maximum amount?
A.
$400,000
B.
$250,000
C.
$100,000
D.
$150,000
Question #42
The HITECH Act expands the privacy provisions of HIPAA to include:
A.
corporate owners of covered entities.
B.
friends and family of providers.
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.
Medicaid incentive payments.
B.
Medicare and Medicaid incentive payments.
C.
Medicare incentive payments.
D.
free license renewals as long as they remain in practice.
Question #44
A healthcare provider is not allowed to discuss a patient's medical condition or payment with a person over the phone.
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.
TRUE
B.
FALSE
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