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 rendered in the most appropriate setting.
B.   medical care that is medically necessary and appropriate based on the patient's condition and diagnosis.
C.   medical care rendered by the most appropriate provider.
D.   medical care rendered in the most profitable 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 services are medically necessary.
B.   determine if the provider is in the network.
C.   determine if care is provided by the most appropriate provider.
D.   determine if an employee is covered under the plan.
Question #4
Which of the following plan types does not use a network of providers?
A.   Indemnity plan
B.   EPO plan
C.   PPO plan
D.   HMO plan
Question #5
All the following are true regarding HMOs EXCEPT:
A.   encourage preventative health services.
B.   require a referral for specialist services.
C.   regulated by federal and state law.
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.   $2,000.00
B.   $250.00
C.   $500.00
D.   $1,000.00
Question #7
The most restrictive type of managed care plan is the:
A.   individual practice association (IPA).
B.   preferred provider organization (PPO).
C.   health maintenance organization (HMO).
D.   exclusive provider organization (EPO).
Question #8
A characteristic of a staff model health maintenance organization (HMO) is that it:
A.   agrees to contractual discounts with physicians.
B.   contracts with a multispecialty physician group.
C.   employs salaried physicians.
D.   is a decentralized healthcare delivery system.
Question #9
All of the following are government plans under the Affordable Care Act EXCEPT:
A.   catastrophic.
B.   titanium.
C.   bronze.
D.   silver.
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.   network model.
C.   staff model.
D.   individual practice association (IPA) 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.   network model.
C.   group model.
D.   staff 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.   group model.
D.   network model.
Question #13
Disadvantages of managed care include all of the following EXCEPT:
A.   It creates an increased administrative burden.
B.   It includes disease management programs based on recent research.
C.   It may require physicians to carry additional malpractice insurance.
D.   It restricts physicians' latitude in caring for patients.
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.   outpatient.
D.   major medical.
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.   medical insurance.
D.   long-term care.
Question #16
Which of the following is true of managed care contracts with providers?
A.   They are irrevocable by the managed care organization (MCO).
B.   Providers must provide a 1-year notice to cancel the contract.
C.   They are usually 1-year contracts.
D.   They are irrevocable by the provider.
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.   be paid for services provided.
B.   be listed in the provider directory.
C.   increase patient load.
D.   increase revenue.
Question #18
An insurance identification card usually includes all of the following information EXCEPT:
A.   detailed benefit information.
B.   name of the insurance policy.
C.   name of the subscriber.
D.   insurance policy number.
Question #19
Insurance information obtained by the medical office specialist:
A.   updated on a regular basis.
B.   All of these.
C.   should be kept in the medical record.
D.   verified with the insurance company.
Question #20
Which type of statement signed by the patient authorizes his or her insurance company to send payments directly to the provider?
A.   beneficiary designation
B.   assignment of benefits
C.   authorization to release protected health information
D.   advance directive
Question #21
A physician who coordinates a patient's care and refers patients to specialists is a(n):
A.   primary care physician (PCP).
B.   primary physician coordinator (PPC).
C.   referring gatekeeper.
D.   preferred provider physician (PPP).
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.   26
B.   18
C.   24
D.   21
Question #23
The Patient Protection and Affordable Care Act requires that all individuals have health insurance beginning in:
A.   2015
B.   2012
C.   2014
D.   2013
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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