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WorksheetsMA: Ch 9
Total questions: 31
Worksheet time: 16mins
What do the benefits of a health insurance policy provide?
Liability protection in case of an accident
Payments to help cover the cost of healthcare services
Free health care
Payments to survivors after a person’s death
Which of the following is true of health insurance companies?
They all offer the same policies and benefits
They all have the same claim procedures
They only offer policies through employers’ group plans
They offer many different policies and costs vary widely
Where is an MA most likely to find detailed information about an insurance company’s claim procedures and benefits?
In a printed manual that contains information on all insurance companies
On a patient’s insurance card
On a website or online portal for the insurance company
In the facility’s policy and procedure manual
What does it mean for a person to be eligible in relation to health insurance?
The person has passed a physical examination.
The person is able to receive benefits.
The person is up-to-date with filing claims.
The person has not made any major claims yet in the calendar year.
Juanita pays 10% of all charges for health care she receives from a provider in her insurance company’s network. She pays 30% of charges if the provider is not in the network. What are these payments called?
Coinsurance
Copayments
Premiums
Deductibles
Each year the Okechi family must pay healthcare costs in full until they have spent $1000. After that, their insurance company's benefits pay for part of their costs. What is the $1000 payment called?
Coinsurance
Copayment
Premium
Deductible
The Woods family has had a lot of healthcare expenses this year. Two family members have been in the hospital and one has had a long course of physical therapy. Because they have spent so much on their share of healthcare costs, their insurance company will pay 100% of healthcare costs for the rest of the year. This is because they have paid their
Premium
Deductible
Out-of-pocket maximum
Allowable amount
After healthcare claims are made, the subscriber gets a(n) _______________ and the provider gets a(n) _______________.
Coverage alert document; summary of payments
Summary of payments; coverage alert document
Remittance advice statement; explanation of benefits
Explanation of benefits; remittance advice statement
The standard fee an insurance company will pay for a healthcare service is called the
Charge limit
Allowable amount
Capitation fee
Premium
What are the four tiers of insurance plans on healthcare.gov’s insurance marketplace?
Basic, enhanced, standard, and premium
Bronze, silver, gold, and platinum
Small, medium, large, and extra-large
Minimal, complete, comprehensive, and expanded
Which of the following is an example of an exclusionary rider?
An insurance company charges higher coinsurance amounts for out-of-network care.
An insurance company will not pay for nonemergency care at out-of-network facilities.
An insurance company does not accept new subscribers with cancer.
An insurance company limits the number of treatments it will approve for a particular condition.
This is the most affordable managed care plan. Patients must see providers in the plan’s network except in an emergency.
HMO
PPO
EPO
How might a medical office be involved in a patient’s claim for disability insurance?
The office receives payments and credits them to the patient’s account.
The office files claims for the patient and the patient is paid directly.
The office acts as a mediator between the patient and the insurance company to determine the payment amount.
The provider certifies that the patient is unable to work.
A patient who is laid off from her job may be able to pay to extend her group insurance because of this law:
The Health Insurance Portability and Accountability Act (HIPAA)
The Consolidated Omnibus Budget Reconciliation Act (COBRA)
The Affordable Care Act (ACA)
The Patient Self-Determination Act (PSDA)
Prescription drugs are covered by Medicare
Part A
Part B
Part C
Part D
Which part of Medicare is optional and is also called a Medicare Advantage Plan?
Part A
Part B
Part C
Part D
TRICARE is a government-funded insurance program for
Elderly people
People with low incomes
People associated with the US military
People who are federal employees of any kind
Children in a family with an income slightly too high to qualify for Medicaid may be covered by this program:
CHAMPVA
CHIP
Medicare
COBRA
Marek and George, a teacher and an architect, are new parents. Each has health insurance through their work. Marek’s birthday is January 10. George’s birthday is October 4. What insurance policy will likely cover their new baby?
Marek’s insurance
George’s insurance
CHIP
What form must a patient sign to allow an insurance company to make payments directly to a healthcare provider?
Coordination of benefits form
Assignment of benefits form
Election of coverage form
Confidentiality practices form
Which of the following may cause an insurance claim to be rejected?
No illness was diagnosed during the exam.
The patient has not met his deductible.
The services provided do not match the patient’s diagnosis.
A locum tenens provider treated the patient.
What must be entered on a claim for services that require preauthorization?
A request for preauthorization
A statement from the provider that the service was necessary
Documentation from the patient’s record of the medical need for the service
A preauthorization number
Before receiving healthcare services not covered by Medicare, a Medicare beneficiary must sign a(n)
Acceptance of Noncoverage
Waiver of Reimbursement
Acknowledgment of Denial
Advance Beneficiary Notice
Why are coding systems used in health care?
They allow providers to communicate with each other secretly.
They make it easier for insurance companies to deny payment.
They provide clear explanations to patients of the care received.
They provide a uniform way to communicate about diagnosis and treatment.
What does the CM in ICD-CM stand for?
Clinical modification
Coding method
Cost modification
Care methodology
Only used for hospital inpatient procedures
ICD-10-CM codes
ICD-10-PCS codes
ICD-11 codes
Coding systems developed by each hospital
What category of CPT code is most commonly used for routine outpatient visits?
Medicine
Pathology/laboratory
Evaluation and management
Radiology
Which of these healthcare services is likely to have a bundled code?
A COVID-19 booster shot
A routine physical exam
A hip replacement
An office visit for a suspected urinary tract infection
If a provider uses a code for an encounter with a lower level of complexity than what is actually involved, what is one likely result?
The provider will be audited.
The insurance company will reject the claim.
The patient will be overcharged.
The provider will not be fully paid for the services provided.
When unbundling is done intentionally it is considered to be
Fraud
Waste
Abuse
Downcoding
What is an insurance company likely to do if a procedure code on a claim does not relate clearly to the diagnosis code?
Accuse the provider of fraud
Deny the claim
Refer the claim to law enforcement
Conduct an audit
