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MED112 CODE/BILL
MED112 PRACTICE QUIZ CH 08
| Question | Answer |
|---|---|
| MED112 PRACTICE QUIZ CH 08 | |
| What does a group health plan (GHP) provide? A. Medicare benefits only B. Healthcare coverage for employees and families C. Dental benefits only D. Workers’ compensation only | B. Healthcare coverage for employees and families |
| A document that modifies an insurance contract is called a A. formulary B. deductible C. rider D. copayment | C. rider |
| A carve out in an employer-sponsored plan means A. increasing deductibles B. changing part of a standard health plan C. eliminating copayments D. adding Medicare coverage | B. changing part of a standard health plan |
| During an open enrollment period, employees A. pay claims B. appeal denials C. choose benefits for the upcoming period D. change providers daily | C. choose benefits for the upcoming period |
| The FEHB program primarily covers A. military contractors only B. uninsured citizens C. federal employees and retirees D. Medicaid recipients | C. federal employees and retirees |
| Self-funded health plans are regulated by A. HIPAA B. COBRA C. ERISA D. ACA | C. ERISA |
| What document explains benefits and legal rights for members of a self-funded health plan? A. Explanation of Benefits B. Summary Plan Description C. Participation Contract D. Utilization Review Report | B. Summary Plan Description |
| A third-party administrator (TPA) may handle A. surgery only B. hospital accreditation only C. claims processing and premium collection D. prescription writing | C. claims processing and premium collection |
| A Section 125 cafeteria plan allows employees to A. avoid insurance enrollment B. pay insurance costs with pretax dollars C. receive free healthcare D. waive deductibles permanently | B. pay insurance costs with pretax dollars |
| The maximum waiting period before insurance becomes effective is generally A. 30 days B. 60 days C. 90 days D. 120 days | C. 90 days |
| A late enrollee is someone who A. misses a copayment B. enrolls outside the normal enrollment period C. changes employers frequently D. loses insurance coverage | B. enrolls outside the normal enrollment period |
| A formulary is A. a list of approved drugs B. an insurance contract C. a provider network D. a surgical authorization form | A. a list of approved drugs |
| COBRA allows terminated employees to continue coverage for approximately A. 6 months B. 12 months C. 18 months D. 36 months | C. 18 months |
| PPO participating providers are usually paid by A. salary B. capitation only C. discounted fee-for-service D. bundled payment only | C. discounted fee-for-service |
| Members of a PPO may see out-of-network providers A. only with hospitalization B. without a referral C. only during emergencies D. only after surgery | B. without a referral |
| In a staff-model HMO, physicians are generally paid through A. salary B. coinsurance C. fee-for-service only D. patient reimbursement | A. salary |
| In an IPA model HMO, providers usually A. work only in hospitals B. own separate practices and contract together C. work directly for Medicare D. are federal employees | B. own separate practices and contract together |
| Consumer-driven health plans combine a high-deductible plan with A. Medicaid funding B. workers’ compensation C. tax-preferred savings accounts D. dental-only coverage | C. tax-preferred savings accounts |
| Which funding option requires an employer to set aside money for healthcare expenses? A. HRA B. HSA C. PPO D. IPA | A. HRA |
| Which account allows both employer and employee contributions? A. HRA B. FSA C. IPA D. POS | B. FSA |
| Which organization developed HEDIS performance measures? A. CMS B. NCQA C. OSHA D. ERISA | B. NCQA |
| Credentialing refers to A. processing claims B. collecting deductibles C. verifying provider qualifications D. assigning ICD-10 codes | C. verifying provider qualifications |
| The ACA created metal plans named A. copper, steel, titanium, iron B. bronze, silver, gold, platinum C. silver, platinum, diamond, ruby D. bronze, copper, silver, titanium | B. bronze, silver, gold, platinum |
| A health insurance exchange (HIX) is A. a hospital billing office B. a government-regulated insurance marketplace C. a pharmacy network D. a provider credentialing agency | B. a government-regulated insurance marketplace |
| Which section of a participation contract includes fees and filing deadlines? A. Introductory section B. Physician responsibilities C. Compensation and billing guidelines D. Covered medical services | C. Compensation and billing guidelines |
| Silent PPOs may cause a provider to A. lose medical records B. unknowingly accept discounted payments C. increase copayments illegally D. deny all claims automatically | B. unknowingly accept discounted payments |
| Elective surgery usually requires A. no documentation B. preauthorization C. immediate hospitalization D. Medicare approval only | B. preauthorization |
| A utilization review organization evaluates A. employee salaries B. provider credentials C. medical necessity D. patient eligibility only | C. medical necessity |
| A plan summary grid is mainly used as A. a patient bill B. a quick-reference table for plan details C. an insurance application D. a surgical consent form | B. a quick-reference table for plan details |
| Under capitated contracts, practices must carefully verify A. provider birthdays B. patient eligibility C. tax returns D. prescription costs only | B. patient eligibility |
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