WorksheetsMoini CH14 Medical Insurance
Total questions: 25
Worksheet time: 13mins
Name
Class
Date
1.
The range of fees charged by most physicians in a community is called the (a)
Choose from the below words
customary fee.
reasonable fee.
usual fee.
premium
average fee.
2.
If a child is covered by both of her parents’ insurances and the total medical charges come to $365—$280 of which is covered by the primary insurance—how are the rest of the charges handled?
a)
The parents are billed for $85.
b)
A claim is submitted to secondary insurance for $85.
c)
A claim is submitted to secondary insurance for $365.
d)
The doctor writes off $85, and no one is charged.
e)
A claim is submitted to secondary insurance for $280.
3.
Which of the following is an example of fraud?
a)
miscoding a diagnosis unintentionally
b)
leaving a field blank on the CMS-1500 by mistake
c)
altering a patient’s chart to increase the amount reimbursed
d)
releasing patient’s medical records without the patient’s consent to the patient’s wife because you feel morally obligated to do so
e)
all of these
4.
Which of the following Medicare programs covers hospital charges? (a)
Choose from the below words
Part A
Part B
Part C
Part D
both Parts A and B
5.
Assume that John Smith got an X-ray through Dr. Jones, a participating provider in Mr. Smith’s HMO. The allowed charge for such an X-ray is $75, but Dr. Jones’s usual fee is $100. John Smith’s copayment due for each office visit is $15. How much can Dr. Jones collect from Mr. Smith?
a)
25
b)
10
c)
15
d)
0
e)
75
6.
Which of the following types of medical insurance is designed to offset medical expenses resulting from catastrophic or prolonged injury or illness?
a)
basic medical
b)
hospital coverage
c)
disability protection
d)
liability insurance
e)
major medical
7.
Capitation is
a)
payment at the time of service.
b)
fixed prospective payment for services provided.
c)
fixed payment made for each enrolled patient rather than reimbursement based on the type and number of services provided.
d)
various payments for specific services provided during a specified time period.
e)
a reduction in payment if services are not provided to a minimum number of enrolled patients.
8.
Providers are required by law to file which of the following for all eligible Medicare patients?
a)
CMS
b)
HCPCS
c)
ICD-9
d)
RBRVS
e)
CMS-1500
9.
A patient’s medical fees come to a total of $600 from a participating provider, and the EOB lists the following information. Charges: $78 Not Eligible for Payment: List item Allowed Charge: $63 Applied to Deductible: $7 Coinsurance: $5 Amount Due from Carrier: $51 What amount is the patient required to pay?
a)
7
b)
5
c)
27
d)
12
e)
nothing
10.
In the staff model HMO
a)
providers are employees of the HMO.
b)
the HMO has capitation contracts with provider groups.
c)
contracts exist with an administrative group of physicians that in turn contracts with members.
d)
plan members can see out-of-network providers for additional fees.
e)
providers are paid on a fee-for-service basis.
11.
Which of the following is a federal health insurance plan?
a)
preferred provider organization (PPO)
b)
health maintenance organization (HMO)
c)
indemnity
d)
Medicare
12.
Which of the following terms describes a statement indicating that a patient has agreed to pay for a service that is likely to be rejected by Medicare?
a)
right to know
b)
promissory note
c)
negotiated fee-for-service
d)
assignment of benefits
e)
advance beneficiary notice
13.
When a child is covered by separate insurance policies through each parent, the policy of which parent is considered primary?
a)
either parent
b)
the parent whose birthday falls last
c)
the parent whose birthday falls first
d)
the father
e)
the mother
14.
Which of the following taxes is mandated by the federal government to be withheld from an employee’s paycheck?
a)
Medicare
b)
state tax
c)
self-employment tax
d)
federal unemployment tax
e)
city tax
15.
Which of the following terms best describes a part of an insurance plan in which a specified dollar amount is paid to physicians based on each patient served, rather than by services performed?
a)
coordination of benefits
b)
copayment
c)
fee-for-service
d)
capitation
e)
coinsurance
16.
The reimbursement system for Medicare Part A payments to hospitals is based on which of the following?
a)
patient’s severity of illness
b)
patient’s level of income
c)
patient’s age
d)
patient’s disease
e)
patient’s prognosis
17.
Which of the following is a document that describes the reason for a denied insurance claim?
a)
explanation of benefits form
b)
Medicare audit form
c)
patient encounter form
d)
advanced beneficiary notice form
e)
CMS-1500 form
18.
Which of the following is the insurance program that provides for the medically indigent?
a)
Medicare
b)
Medicaid
c)
Blue Cross
d)
TRICARE
e)
HMO
19.
Which of the following is a prepaid health insurance plan?
a)
health maintenance organization (HMO)
b)
preferred provider organization (PPO)
c)
TRICARE
d)
Medicaid
e)
Medicare
20.
Which of the following steps must be taken to ensure coverage by a patient’s insurance company before the patient undergoes surgery to repair a rotator cuff?
a)
verifying the amount of the patient’s copayment and deductible
b)
estimating the cost of the surgery
c)
documenting preexisting illnesses
d)
completing a certificate of need application
e)
precertifying the surgical procedure
21.
Which of the following insurance plans recommends that an individual person’s previous medical records should be kept separate from those detailing an injury while on the job?
a)
Medicare
b)
Medicaid
c)
Workers’ compensation
d)
Blue Cross/Blue Shield
e)
Tricare
22.
Which of the following involves fixed payments by a Health Maintenance Organization (HMO) to a physician or hospital on a per person, per month basis?
a)
copayment
b)
capitation
c)
private pay
d)
fee-for-service
e)
group model HMO managed care
23.
Which of the following plans covers spouses of veterans with permanent, service-related disabilities?
a)
Medicaid
b)
Medicare
c)
Medigap
d)
CHAMPVA
e)
CHAMPUS
24.
Which of the following types of insurance covers medical expenses for patients who are injured on a physician’s property?
a)
workers’ compensation
b)
overhead
c)
disability protection
d)
special risk
e)
liability
25.
Which of the following is based on a database of charges for a service to other patients by the same type of provider?
a)
rider
b)
usual fee
c)
reasonable fee
d)
usual, customary, and reasonable fee
e)
customary fee
100 %
