MOA 183 - Medical Billing and Coding » Fall 2020 » Chapter 3 Quiz

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Question #1
Managed care organizations (MCOs) develop a network by contracting with:
A.   All of these.
B.   physicians.
C.   facilities.
D.   pharmacies.
Question #2
The benefits of a managed care contract to the provider include:
A.   keeping costs down.
B.   increasing administrative duties.
C.   bringing more patients to the practice.
D.   adding opportunities for staff development.
Question #3
Which of the following is NOT a common type of payment arrangement in a managed care contract?
A.   discounted fee-for-service
B.   capitation
C.   per case
D.   annual fee
Question #4
An increase in patient volume is often caused by:
A.   percentage of premium and capitation contracts.
B.   discounted fee-for-service contracts.
C.   capitation contracts.
D.   per diem and per case contracts.
Question #5
A contract with which of the following payment terms can result in an increased financial risk to the provider?
A.   percentage of premiums
B.   discounted fee-for-service
C.   capitation
D.   fee-for-service
Question #6
Which type of payment method creates an incentive to provide more preventive care?
A.   capitation
B.   per case
C.   discounted fee-for-service
D.   per diem
Question #7
All the following are true regarding an ACO EXCEPT:
A.   It needs a patient's authorization to release medical information.
B.   It participates in a Medicare Shared Savings Program.
C.   It shares the patient's information with its network of providers.
D.   It is part of a Medicare Advantage plan.
Question #8
Business values incorporated into medical practices as a result of managed care include a(n):
A.   emphasis on the doctor—patient relationship.
B.   return to fee-for-service payments.
C.   focus on efficiency, cost reduction, and profit.
D.   focus on administrative requirements and paperwork.
Question #9
The Affordable Care Act represents the most significant overhaul of the U.S. healthcare system since:
A.   the passing of Medicaid.
B.   the passing of Medicare.
C.   Both the passing of Medicaid and the passing of Medicare.
D.   the passing of Obamacare.
Question #10
The following is true of Obamacare:
A.   employers are mandated to furnish healthcare or be fined.
B.   All of these.
C.   requires all insurance plans to cover contraceptives at no cost.
D.   preventative care is more accessible.
Question #11
A medical office specialist works as a liaison between: (Select all that apply),,
A.   the provider and carrier.
B.   the provider and patient.
C.   the patient and employer.
D.   the employer and carrier.
Question #12
In cases of fraudulent billing:
A.   the medical office specialist can be held liable.
B.   only the physician can be held liable.
C.   the physician can never be held liable.
D.   the medical office specialist can never be held liable.
Question #13
When a person has health insurance coverage through two or more plans, the determination of which plan will provide benefits as primary or secondary payer is known as:
A.   benefit determination.
B.   case management.
C.   coordination of benefits.
D.   coordination of services.
Question #14
Medically necessary services include all of the following EXCEPT services that are:
A.   based on recognized standards of the specialty involved.
B.   experimental, investigative, or unproven.
C.   accepted by the healthcare profession as appropriate and effective for the condition being treated.
D.   not solely for the convenience of a covered person or a healthcare provider.
Question #15
An individual who is an insured, enrolled subscriber or dependent under the terms of a health benefit plan is a(n):
A.   covered person.
B.   payer.
C.   provider.
D.   contracted entity.
Question #16
The contract provision that states a physician cannot seek payment from a patient under a managed care contract in relation to any benefit penalties that were applied based on a utilization review decision is:
A.   no fault.
B.   hold harmless.
C.   stoploss coverage.
D.   liability.
Question #17
Principles adopted in the Patient's Bill of Rights include all of the following EXCEPT the right to:
A.   sue the managed care organization.
B.   receive emergency services without penalty.
C.   accurate and easily understood information.
D.   know your treatment options.
Question #18
All of the following regarding the Patient's Bill of Rights are true EXCEPT:
A.   Patients can receive preventative care without paying deductibles, coinsurance, or copayments.
B.   Patients joining a new plan can choose their own doctor in the insurer network.
C.   Patients have the right to appeal an insurance company decision with an independent third party.
D.   Patients may receive financial reimbursement for out of network penalties.
Question #19
Which of the following is true of the new Patient's Bill of Rights under the Affordable Health Care Act?
A.   Insurance companies are prohibited from charging patients for preventative care.
B.   Insurance companies are banned from restricting emergency room care.
C.   Insurance companies are banned from limiting choice of doctors.
D.   All of these.
Question #20
Which of the following are new laws in the Patient's Bill of Rights under the Affordable Care Act?
A.   All of these.
B.   a patient cannot be dropped from coverage due to an unintentional mistake on their application.
C.   insurance companies can no longer put a lifetime limit of the amount of coverage.
D.   no one can be denied coverage because of a pre-existing medical condition.
Question #21
A managed care contract that involves payment through capitation provides incentives for physicians to emphasize preventive care.
A.   TRUE
B.   FALSE
Question #22
A medical office specialist cannot be held liable for fraudulent billing practices if told to do so by a physician.
A.   FALSE
B.   TRUE
Question #23
The Patient's Bill of Rights under the Affordable Care Act put an end to insurance companies limiting choice of doctors.
A.   TRUE
B.   FALSE
Question #24
A medical office specialist should always document, sign, and date all conversations regarding any patient's account.
A.   TRUE
B.   FALSE

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