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Lesson 8
Insurance Plans
| Question | Answer |
|---|---|
| 1. In UCR fees the portion that's based on what doctors with similar training charge in a specific area is known as the _____ fee | C. Customary |
| 2. Which one of the following types of insurance plans is state licensed and has the most stringent MCO guidelines? | B. HMO |
| 3. Which of the following types of insurance plans combines features of a health maintenance organization and an preferred provider organization where the employers don't contract with other plans? | A. EPO |
| 4. The specified amount of out-of-pocket medical expenses that the insured pays annually before the health insurance policy provides coverage is called the | C. Deductible |
| 5. A POS plan allows patients to | B. Use in-network or out-of-network providers |
| 6. If negotiated managed care fees are too low, how could a physician make up the difference in payments? | C. see more patients |
| 7. You pay additional expenses to cover the huge medical expenses that aren't covered by your normal policy. Which type of insurance do you have | D. major medical |
| 8. When an MCO keeps a percentage of a physicians revenue until year end its referred to as | A. pay for performance |
| 9. A regularly scheduled payment made to purchase an insurance policy is known as the | C. premium |
| 10. Which on of the following choices is a disadvantage of managed care? | A. the MCO may suggest a plan of care that differs from the physicians plan. |
| 11. Mrs. Smith is a widow who had previously received coverage through her husbands insurance. Mrs. Smith can continue to receive coverage under | A. COBRA |
| 12. Which one of the following choices represents a disadvantage of managed care organizations? | A. There are issues with providing services in emergency situations. |
| 13. Before 1993, how did people pay for their healthcare services? | C. with their own private funds |
| 14. You just changed to a plan that's priced lower than your previous PPO but higher than an HMO, You are probably using a(n) | B. EPO |
| 15. Which one of the following choices can increase costs in managed care? | C. preauthorization's |
| 16. Delivering high-quality care that manages cost is a goal of | D. managed care |
| 17. Which one of the following choices represents a common criticism of MCOs? | A. Patients can't appeal the decision if the MCO says that a particular treatment isn't medically necessary |
| 18. Which on of the following outcomes was a result of physicians being excessively sued? | A. the ordering of extra tests and treatments so the physician could protect himself or herself. |
| 19. You're a medical office specialist who just asked a patient if she has health insurance. What is probably your next step? | C. Ask to see the patients ID card |
| 20. Which one of the following types of insurance is considered some of the least expensive insurance? | D. catastophic |
| 21. When multiple doctors become employees of a group practice and contract with an MCO to deliver healthcare to members of the network. They're probably participating in a(n) ___________ model. | D. group |
| 22. Healthcare plans administered by a TPA are typically which type of plan? | C. self-insured plan |
| 23. When a physician agrees to accept a payment directly form the payments insurer, its called | C. assignment of benefits |
| 24. In 1982, which one of the following choices made it easier for HMOs to work with Medicare? | D. TEFRA |
| 25. Which one of the following choices is an important reason for medical office specialist to understand the history of health care in America ? | B. It will help them better communicate with patients |
| 26. Options available through managed care organizations include the preferred provider organization (PPO), the point-of-service plan (POS), and the | C. Health maintenance organization (HMO) |
| 27. IF you want protection against a certain type of accident or illness, which insurance should you get? | C. special risk |
| 28. You have to pay $250 before your insurance begins. This amount is known as the | D. deductible |
| 29. How do you determine how much a carrier is responsible for paying? | B. subtract the unpaid deductible or copay from the write-off amount |
| 30. If an insurance carrier's rate of benefit is 85 percent, what is the patient's coinsurance? | D. 15% |
Created by:
Lulumac16