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.   facilities.
C.   All of these.
D.   pharmacies.
Question #2
The benefits of a managed care contract to the provider include:
A.   keeping costs down.
B.   bringing more patients to the practice.
C.   increasing administrative duties.
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.   capitation
B.   annual fee
C.   discounted fee-for-service
D.   per case
Question #4
An increase in patient volume is often caused by:
A.   capitation contracts.
B.   percentage of premium and capitation contracts.
C.   discounted fee-for-service 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.   capitation
B.   percentage of premiums
C.   fee-for-service
D.   discounted fee-for-service
Question #6
Which type of payment method creates an incentive to provide more preventive care?
A.   per diem
B.   capitation
C.   per case
D.   discounted fee-for-service
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.   focus on efficiency, cost reduction, and profit.
B.   focus on administrative requirements and paperwork.
C.   return to fee-for-service payments.
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 Medicaid.
B.   Both the passing of Medicaid and the passing of Medicare.
C.   the passing of Medicare.
D.   the passing of Obamacare.
Question #10
The following is true of Obamacare:
A.   preventative care is more accessible.
B.   employers are mandated to furnish healthcare or be fined.
C.   requires all insurance plans to cover contraceptives at no cost.
D.   All of these.
Question #11
A medical office specialist works as a liaison between:
A.   the patient and employer & the provider and carrier
B.   the patient and employer & the employer and carrier
C.   the provider and patient & 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 benefits.
B.   benefit determination.
C.   case management.
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.   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.   payer.
B.   covered person.
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.   hold harmless.
B.   no fault.
C.   liability.
D.   stoploss coverage.
Question #17
Principles adopted in the Patient's Bill of Rights include all of the following EXCEPT the right to:
A.   know your treatment options.
B.   receive emergency services without penalty.
C.   accurate and easily understood information.
D.   sue the managed care organization.
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 may receive financial reimbursement for out of network penalties.
C.   Patients have the right to appeal an insurance company decision with an independent third party.
D.   Patients joining a new plan can choose their own doctor in the insurer network.
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 banned from limiting choice of doctors.
B.   Insurance companies are prohibited from charging patients for preventative care.
C.   Insurance companies are banned from restricting emergency room care.
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.   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.   TRUE
B.   FALSE
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.   TRUE
B.   FALSE
Question #25
A managed care contract specifies covered services, reimbursement amounts, and the method of ________ for the contracted physician.
A.   renewal
B.   compensation
C.   coverage
D.   grant

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