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.
discounted fees for services and mandatory high deductibles across all health plans.
B.
prohibiting the use of out-of-network providers.
C.
provider networks and discounted fees for services.
D.
provider networks and regular premium increases.
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.
family practitioner.
B.
internal medicine doctor.
C.
dermatologist.
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.
coordinating patient care.
C.
All of these.
D.
referring patients to specialists.
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.
expenses must have incurred during the coverage period.
B.
participation ends upon termination of employment.
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.
maintain their income.
C.
minimize malpractice suits.
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.
Members must obtain referrals to see a specialist.
B.
It includes a contracted network of providers.
C.
Members select a primary care physician (PCP) as a gatekeeper.
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.
Physicians run the risk of unfavorable evaluations by enrollees.
B.
Providers strive to improve the quality of their care.
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.
gatekeepers.
C.
a limited provider network.
D.
a flexible benefit design.
Question #14
Physician-hospital organizations (PHOs) may include:
A.
laboratories.
B.
All of these.
C.
nursing homes.
D.
surgery centers.
Question #15
Group insurance is issued to an employer to provide coverage for:
A.
employees and all their dependents.
B.
employees and children only.
C.
employees 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.
special risk insurance.
B.
major medical insurance.
C.
long-term care insurance.
D.
short-term health 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.
permanent provider.
B.
participating provider.
C.
active provider.
D.
MCO provider.
Question #19
A managed care contract will include a:
A.
list of patients covered by the plan.
B.
description of what types of employer groups are offered coverage.
C.
description of how the physician will be paid for services.
D.
list of physicians in the network.
Question #20
Under a discounted fee-for-service arrangement, covered services are compensated at a:
A.
discounted per-diem rate.
B.
reduced percentage of usual and customary charges.
C.
per-member-per-month rate.
D.
reduced per-case 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.
take legal action against the MCO.
C.
bill the patient directly.
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.
treat the patient as much as possible without a specialist referral unless absolutely necessary.
B.
make frequent referrals to contracted network specialists.
C.
see as many patients each day as possible, even if this means less time with each patient.
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.
physicians.
B.
managers.
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.
workplace environment.
C.
service fees.
D.
medical credentials.
Question #25
With respect to National Committee for Quality Assurance (NCQA) accreditation:
A.
accredited MCOs are always better than nonaccredited MCOs.
B.
MCOs have all asked to be accredited, but some do not qualify.
C.
MCOs must be accredited to operate.
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.
25
C.
26
D.
19
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.
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.
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.
health insurance claims
B.
eligibility requests and verifications
C.
claim status requests and reports
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.
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.
The U.S. Food and Drug Administration requests it in relation to a product recall.
B.
A coroner requests it to assist in identifying a body.
C.
All of these
D.
An organ procurement organization requests it to facilitate the donation and transplantation of organs.
Question #36
A.
designate a specific person at an insurance company who may also have access.
B.
at least 10 free copies.
C.
file a complaint about how long it takes to get a claim paid.
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.
individuals whose records were affected.
C.
Centers for Medicare and Medicaid Services (CMS).
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.
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.
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.
$250,000
B.
$100,000
C.
$400,000
D.
$150,000
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 patients.
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.
Medicare incentive payments.
B.
Medicaid incentive payments.
C.
free license renewals as long as they remain in practice.
D.
Medicare and Medicaid 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
A.
FALSE
B.
TRUE
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