MOA 183 - Intro to Health Insurance » Fall 2022 » Weekly Quiz 2 Chapter 3

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Question #1
Managed care organizations (MCOs) develop a network by contracting with:
A.   physicians.
B.   All of these.
C.   pharmacies.
D.   facilities.
Question #2
The benefits of a managed care contract to the provider include:
A.   adding opportunities for staff development.
B.   increasing administrative duties.
C.   keeping costs down.
D.   bringing more patients to the practice.
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.   discounted fee-for-service contracts.
B.   percentage of premium and capitation contracts.
C.   per diem and per case contracts.
D.   capitation 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.   fee-for-service
C.   capitation
D.   discounted fee-for-service
Question #6
Which type of payment method creates an incentive to provide more preventive care?
A.   capitation
B.   per case
C.   per diem
D.   discounted fee-for-service
Question #7
All the following are true regarding an ACO EXCEPT:
A.   It shares the patient's information with its network of providers.
B.   It needs a patient's authorization to release medical information.
C.   It is part of a Medicare Advantage plan.
D.   It participates in a Medicare Shared Savings Program.
Question #8
Business values incorporated into medical practices as a result of managed care include a(n):
A.   return to fee-for-service payments.
B.   focus on administrative requirements and paperwork.
C.   focus on efficiency, cost reduction, and profit.
D.   emphasis on the doctor—patient relationship.
Question #9
The Affordable Care Act represents the most significant overhaul of the U.S. healthcare system since:
A.   the passing of Medicare.
B.   the passing of Obamacare.
C.   Both the passing of Medicaid and the passing of Medicare.
D.   the passing of Medicaid.
Question #10
The following is true of Obamacare:
A.   employers are mandated to furnish healthcare or be fined.
B.   All of these.
C.   preventative care is more accessible.
D.   requires all insurance plans to cover contraceptives at no cost.
Question #11
A medical office specialist works as a liaison between:
A.   the provider and patient & the employer and carrier
B.   the patient and employer & the provider and carrier
C.   the patient and employer & the employer and carrier
D.   the provider and patient & the provider 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.   coordination of services.
B.   benefit determination.
C.   coordination of benefits.
D.   case management.
Question #14
Medically necessary services include all of the following EXCEPT services that are:
A.   based on recognized standards of the specialty involved.
B.   not solely for the convenience of a covered person or a healthcare provider.
C.   experimental, investigative, or unproven.
D.   accepted by the healthcare profession as appropriate and effective for the condition being treated.
Question #15
An individual who is an insured, enrolled subscriber or dependent under the terms of a health benefit plan is a(n):
A.   provider.
B.   covered person.
C.   contracted entity.
D.   payer.
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.   liability.
B.   stoploss coverage.
C.   no fault.
D.   hold harmless.
Question #17
Principles adopted in the Patient's Bill of Rights include all of the following EXCEPT the right to:
A.   receive emergency services without penalty.
B.   sue the managed care organization.
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 have the right to appeal an insurance company decision with an independent third party.
B.   Patients joining a new plan can choose their own doctor in the insurer network.
C.   Patients can receive preventative care without paying deductibles, coinsurance, or copayments.
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.   All of these.
D.   Insurance companies are banned from limiting choice of doctors.
Question #20
Which of the following are new laws in the Patient's Bill of Rights under the Affordable Care Act?
A.   no one can be denied coverage because of a pre-existing medical condition.
B.   All of these.
C.   insurance companies can no longer put a lifetime limit of the amount of coverage.
D.   a patient cannot be dropped from coverage due to an unintentional mistake on their application.
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.   FALSE
B.   TRUE
Question #24
A medical office specialist should always document, sign, and date all conversations regarding any patient's account.
A.   FALSE
B.   TRUE
Question #25
A managed care contract specifies covered services, reimbursement amounts, and the method of ________ for the contracted physician.
A.   grant
B.   coverage
C.   renewal
D.   compensation

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