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 by the most appropriate provider.
B.   medical care that is medically necessary and appropriate based on the patient's condition and diagnosis.
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.   ordinary.
B.   usual.
C.   customary.
D.   reasonable.
Question #3
Utilization guidelines are used to:
A.   determine if care is provided by the most appropriate provider.
B.   determine if an employee is covered under the plan.
C.   determine if the provider is in the network.
D.   determine if services are medically necessary.
Question #4
Which of the following plan types does not use a network of providers?
A.   HMO plan
B.   PPO plan
C.   Indemnity plan
D.   EPO plan
Question #5
All the following are true regarding HMOs EXCEPT:
A.   the least restrictive type of care plan.
B.   regulated by federal and state law.
C.   encourage preventative health services.
D.   require a referral for specialist services.
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.   $2,000.00
C.   $250.00
D.   $1,000.00
Question #7
The most restrictive type of managed care plan is the:
A.   health maintenance organization (HMO).
B.   preferred provider organization (PPO).
C.   exclusive provider organization (EPO).
D.   individual practice association (IPA).
Question #8
A characteristic of a staff model health maintenance organization (HMO) is that it:
A.   contracts with a multispecialty physician group.
B.   agrees to contractual discounts with physicians.
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.   bronze.
B.   silver.
C.   catastrophic.
D.   titanium.
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.   staff model.
B.   group model.
C.   individual practice association (IPA) 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.   staff model.
B.   network model.
C.   group model.
D.   individual practice association (IPA) 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 restricts physicians' latitude in caring for patients.
D.   It may require physicians to carry additional malpractice insurance.
Question #14
The type of insurance coverage that provides protection against a specific type of accident or illness is:
A.   major medical.
B.   outpatient.
C.   catastrophic health insurance.
D.   special risk.
Question #15
The type of insurance that provides coverage for a designated period of time is:
A.   special risk.
B.   long-term care.
C.   short-term health insurance.
D.   medical insurance.
Question #16
Which of the following is true of managed care contracts with providers?
A.   They are irrevocable by the provider.
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 managed care organization (MCO).
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 listed in the provider directory.
B.   increase patient load.
C.   increase revenue.
D.   be paid for services provided.
Question #18
An insurance identification card usually includes all of the following information EXCEPT:
A.   insurance policy number.
B.   name of the subscriber.
C.   name of the insurance policy.
D.   detailed benefit information.
Question #19
Insurance information obtained by the medical office specialist:
A.   All of these.
B.   updated on a regular basis.
C.   verified with the insurance company.
D.   should be kept in the medical record.
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.   advance directive
D.   authorization to release protected health information
Question #21
A physician who coordinates a patient's care and refers patients to specialists is a(n):
A.   preferred provider physician (PPP).
B.   primary care physician (PCP).
C.   primary physician coordinator (PPC).
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.   24
B.   21
C.   26
D.   18
Question #23
The Patient Protection and Affordable Care Act requires that all individuals have health insurance beginning in:
A.   2012
B.   2015
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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