Health Care System Quiz

What is the business of shifting the risk of loss from the individual to a third party?

• Risk pooling

• Health care services

• Insurance agreement

• Managed care organization

What percentage of Americans under age 65 purchase private individual health care insurance?

• 15%

• 10%

• 5%

• 20%

Under the Affordable Care Act, what is the maximum percentage of family income that the premium for insurance cannot exceed?

• 5%

• 12%

• 7.5%

• 9.5%

What is the average premium for family coverage in 2014?

• $16,834

• $10,000

• $6,025

• $20,000

What is the term used for the process of correctly coding what diagnoses, procedures, and services were provided to the patient?

• ICD-10-CM

• Coding

• HCPCS

• Billing

What type of third-party payer is exempt from state insurance regulation and is regulated by ERISA?

• Indemnity insurers

• Self-insurers

• Managed care models

• Blue Cross/Blue Shield

Which managed care model requires the patient to obtain specialist and rehabilitative services only if referred by the primary care provider?

• Prepaid health plans (PHPs)

• Health Maintenance Organizations (HMOs)

• Preferred provider organizations (PPOs)

• Exclusive provider organizations (EPOs)

Which act regulates portability, access, and mandated benefits for HMOs and other managed care organizations?

• American Health Benefit Exchanges

• COBRA

• Patient Protection and Affordable Care Act

• HIPAA

What does COBRA stand for in the context of health benefits continuation after leaving an employer?

• Consolidated Omnibus Budget Reconciliation Act

• Corporate Obligations for Business Reimbursement Act

• Comprehensive Options for Benefits Reimbursement Act

• Continuation of Benefits and Retirement Act

Which law requires states to establish American Health Benefit Exchanges and Small Business Health Options Program Exchanges for the uninsured and small businesses to obtain coverage?

• HIPAA

• COBRA

• ERISA

• Patient Protection and Affordable Care Act