Insurance and Coding
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| The type of health insurance that offers the most choices of providers, in which patients can choose any provider they want and change providers at any time is, a (n): | show 🗑
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| Group insurance is typically: | show 🗑
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| The best type of healthcare plan is a (n): | show 🗑
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| show | Everyone who enrolls in a plan under PPACA pays the same premium
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| show | Insurance Cap
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| show | participating provider
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| when the employer-not an insurance company- is responsible for the cost of its employees' medical services, the employer has a : | show 🗑
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| show | Third- party administrator (TPA)
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| Prior to the Affordable Care Act, a person's health insurance coverage that has been in effect for a period of 63 days or more before enrolling in a new health plan is called: | show 🗑
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| The Affordable Care Act states that by 2014, everyone in the United States should have access to a comprehensive set of healthcare benefits, which is referred to as: | show 🗑
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| True or False: With managed healthcare, patients can choose any physician they want and change physicians at any time | show 🗑
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| True or False: Group insurance is generally more expensive because it covers more individuals. | show 🗑
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| show | True.
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| show | True.
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| True or False; Most organizations that are self-insured are large entities, which can draw from hundreds or thousands of enrollees | show 🗑
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| show | False.
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| True or False: If an individual belongs to a BlueCard PPO, the initials PPO appear inside a blue globe. | show 🗑
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| True or False: It is important to consult all types of insurance plans for their specific guidelines to avoid claim delays and rejections. | show 🗑
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| True or False: An explanation of benefits (EOB) is a document prepared by the carrier that gives details of how the claim was adjudicated. | show 🗑
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| True or False: Filing CMS-1500 paper claims for commercial carriers is much the same as with all other carriers. | show 🗑
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| True or False: One of the provisions of healthcare reform was the removal of lifetime caps on insurance | show 🗑
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| True or False: Self-insured plans are not as closely regulated as conventional insurance plans. | show 🗑
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| show | True.
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| Individuals belonging to a managed healthcare plan are commonly referred to as: | show 🗑
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| A specific provider who oversees an HMO member's total healthcare treatment is called a (n): | show 🗑
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| show | Staff model
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| show | Open-panel IPA
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| A system designed to determine the medical necessity and appropriateness of a requested medical service, procedure, or hospital admission prior, concurrent, or retrospective to the event is called: | show 🗑
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| A procedure required by third-party payers that requires permission before a provider can carry out specific procedures and treatments in a (n): | show 🗑
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| show | Medicaid
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| Most MCOs are regulated from three areas. What are they? | show 🗑
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| show | NCQA
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| show | True.
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| show | True.
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| True or False: HMOs are neither accredited nor certified. | show 🗑
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| True or False: Precertification involves collecting information before inpatient admissions or performance of selected ambulatory procedures and services | show 🗑
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| In all managed care situations, for the healthcare plan to recognize the referral, it must come from the patient's designated PCP. | show 🗑
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| show | False.
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| show | Network
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| show | HMO and PPO
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| A(n)_________ is a specific provider who oversees an HMO member's total healthcare treatment. | show 🗑
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| show | HMO
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| A(n)____________ HMO is a multispecialty group practice in which all healthcare services are provided within the building(s) owned by the HMO | show 🗑
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| show | Capitation
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| The____________ HMO is one that has multiple provider arrangements, including staff, group, or IPA structures. | show 🗑
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| show | DCM
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| show | UT
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| show | Utilization Review
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| A(n)_______________ is when the PCP requests another physician to provide his or her expert opinion regarding the patients condition. | show 🗑
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Created by:
missmadison