MOA 183 - Intro to Health Insurance » Fall 2022 » Weekly Quiz 1 Chapter 1 & 2

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Question #1
The goals of managed care include all of the following EXCEPT:
A.   medical care that is medically necessary and appropriate based on the patient's condition and diagnosis.
B.   medical care rendered by the most appropriate provider.
C.   medical care rendered in the most profitable setting.
D.   medical care rendered in the most appropriate setting.
Question #2
Terms that refer to fees in an insurance contract include all of the following EXCEPT:
A.   reasonable.
B.   ordinary.
C.   usual.
D.   customary.
Question #3
Utilization guidelines are used to:
A.   determine if an employee is covered under the plan.
B.   determine if care is provided by the most appropriate provider.
C.   determine if services are medically necessary.
D.   determine if the provider is in the network.
Question #4
Which of the following plan types does not use a network of providers?
A.   HMO plan
B.   EPO plan
C.   PPO plan
D.   Indemnity plan
Question #5
All the following are true regarding HMOs EXCEPT:
A.   require a referral for specialist services.
B.   regulated by federal and state law.
C.   encourage preventative health services.
D.   the least restrictive type of care plan.
Question #6
Beginning in 2014, employers with 50 or more workers who do not offer coverage will be fined what amount for each employee?
A.   $500.00
B.   $250.00
C.   $2,000.00
D.   $1,000.00
Question #7
The most restrictive type of managed care plan is the:
A.   health maintenance organization (HMO).
B.   individual practice association (IPA).
C.   preferred provider organization (PPO).
D.   exclusive provider organization (EPO).
Question #8
A characteristic of a staff model health maintenance organization (HMO) is that it:
A.   is a decentralized healthcare delivery system.
B.   agrees to contractual discounts with physicians.
C.   employs salaried physicians.
D.   contracts with a multispecialty physician group.
Question #9
All of the following are government plans under the Affordable Care Act EXCEPT:
A.   bronze.
B.   silver.
C.   titanium.
D.   catastrophic.
Question #10
The type of health maintenance organization (HMO) plan that involves contracting with individual physicians to create a healthcare delivery system is a(n):
A.   group model.
B.   individual practice association (IPA) model.
C.   staff model.
D.   network model.
Question #11
The type of health maintenance organization (HMO) plan that employs salaried physicians who treat members in facilities owned and operated by the HMO is a(n):
A.   individual practice association (IPA) model.
B.   group model.
C.   staff model.
D.   network model.
Question #12
The type of health maintenance organization (HMO) that contracts with more than one community-based multispecialty group to provide wider geographical coverage is a(n):
A.   individual practice association (IPA) model.
B.   staff model.
C.   network model.
D.   group model.
Question #13
Disadvantages of managed care include all of the following EXCEPT:
A.   It includes disease management programs based on recent research.
B.   It may require physicians to carry additional malpractice insurance.
C.   It restricts physicians' latitude in caring for patients.
D.   It creates an increased administrative burden.
Question #14
The type of insurance coverage that provides protection against a specific type of accident or illness is:
A.   special risk.
B.   catastrophic health insurance.
C.   major medical.
D.   outpatient.
Question #15
The type of insurance that provides coverage for a designated period of time is:
A.   short-term health insurance.
B.   special risk.
C.   long-term care.
D.   medical insurance.
Question #16
Which of the following is true of managed care contracts with providers?
A.   Providers must provide a 1-year notice to cancel the contract.
B.   They are irrevocable by the managed care organization (MCO).
C.   They are irrevocable by the provider.
D.   They are usually 1-year contracts.
Question #17
Providers who contract with managed care organizations (MCOs) must provide care according to the MCO's policies and guidelines in order to:
A.   increase revenue.
B.   be listed in the provider directory.
C.   increase patient load.
D.   be paid for services provided.
Question #18
An insurance identification card usually includes all of the following information EXCEPT:
A.   name of the insurance policy.
B.   insurance policy number.
C.   detailed benefit information.
D.   name of the subscriber.
Question #19
Insurance information obtained by the medical office specialist:
A.   verified with the insurance company.
B.   should be kept in the medical record.
C.   updated on a regular basis.
D.   All of these.
Question #20
Which type of statement signed by the patient authorizes his or her insurance company to send payments directly to the provider?
A.   authorization to release protected health information
B.   advance directive
C.   assignment of benefits
D.   beneficiary designation
Question #21
A physician who coordinates a patient's care and refers patients to specialists is a(n):
A.   primary physician coordinator (PPC).
B.   primary care physician (PCP).
C.   preferred provider physician (PPP).
D.   referring gatekeeper.
Question #22
In 2011, the new health care reform law required insurers to offer dependent coverage for adult children up to age ________ so they could be included on their parents' coverage.
A.   18
B.   21
C.   26
D.   24
Question #23
The Patient Protection and Affordable Care Act requires that all individuals have health insurance beginning in:
A.   2013
B.   2015
C.   2014
D.   2012
Question #24
If a physician has ordered surgery for a patient, a managed care organization (MCO) case manager may disallow an inpatient stay if the MCO guidelines designate the procedure as best suited for outpatient care.
A.   False
B.   True
Question #25
The restrictions in a health maintenance organization (HMO) reduce members' premium costs.
A.   True
B.   False

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