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WorksheetsHealthcare and Insurance Quiz
Total questions: 42
Worksheet time: 21mins
Affordable Care Act (ACA) is best described as:
A law that allows employees to take unpaid time off for medical or family reasons
A law that increased access to health insurance and set rules to protect patients
A type of insurance plan where patients must use doctors in the plan’s network
A request sent to an insurance company asking for payment for medical services
Allowed Charge refers to:
The maximum amount an insurance company will pay for a medical service
A fixed amount a patient pays at each doctor visit
A service that insurance will not pay for
The monthly cost of health insurance
An Appeal is:
A list of covered prescription drugs
A formal complaint filed by a patient
A request to your insurance company to review and change a decision they made
A type of insurance plan with network restrictions
A Brand Name Drug is:
A drug sold under a company’s trademarked name
A drug with the same ingredients but costs less
Any over-the-counter medication
A drug not covered by insurance
A Claim is:
A special account to pay for medical expenses
A request sent to an insurance company asking for payment for medical services
A law that protects patient privacy
An appeal against insurance
Comorbidities occur when:
A patient has two or more medical conditions at the same time
A patient files multiple claims at once
A drug has multiple active ingredients
An insurance company covers more than one family member
A Contract in healthcare is:
A written agreement between a doctor and pharmacist
A legal agreement between a patient, doctor, or insurance company about coverage
A list of covered medical procedures
A monthly insurance payment
A Copayment (Copay) is:
The amount you pay before insurance begins
A fixed amount of money a patient pays at each doctor visit or prescription
The maximum insurance will pay
The list of covered services
CPT Codes are used for:
Diagnosing conditions
Filing grievances
Describing medical services and procedures for billing
Tracking insurance premiums
A Deductible is:
A percentage of the bill patients pay
The amount of money a patient must pay each year before insurance starts paying
A fixed fee at each visit
The monthly premium
Dependent Coverage refers to:
Insurance that covers only the employee
Insurance that covers family members such as children or a spouse
Coverage for chronic illnesses
Coverage after retirement
A Diagnosis is:
A list of prescription drugs
The name for a patient’s illness or condition based on tests and symptoms
A type of outpatient service
A written complaint about treatment
Diagnosis Related Groups (DRGs) are:
A system that decides how much hospitals get paid for treating certain diagnoses
Codes for insurance companies to deny claims
Lists of covered prescription drugs
Groups of patients with chronic conditions
Durable Medical Equipment (DME) includes:
Hospital stays over 24 hours
Medical equipment like wheelchairs, walkers, or oxygen used at home
Generic prescription drugs
Medical coding for billing
An Elective Procedure is:
A surgery needed immediately
A planned medical procedure that is not an emergency
A service denied by insurance
Hospice-related care
Family and Medical Leave Act (FMLA) allows:
Employees to get paid leave for any illness
Employees to take unpaid time off for medical or family reasons without losing their job
Children to stay on their parent’s insurance until age 26
Coverage for dependents at no cost
A Flexible Spending Account (FSA) is:
A savings plan for retirement
A special account employees can use to pay for medical expenses with pre-tax money
A program that provides health insurance for seniors
An insurance premium reduction
A Formulary is:
A set of codes for medical procedures
A list of prescription drugs that an insurance plan covers
A legal agreement about healthcare coverage
A system to group hospital payments
A Generic Drug is:
A drug with the same ingredients as a brand-name drug but usually costs less
A drug sold under a trademark
Any over-the-counter medication
A drug not approved by the FDA
A Grievance is:
A type of drug claim
A formal complaint filed by a patient about insurance or a provider
A request for prior authorization
An appeal filed by an insurance company
Health Maintenance Organization (HMO) is:
A law that protects patient privacy
A government insurance program for seniors
A type of insurance plan where patients must use doctors in the plan’s network
A savings account for medical expenses
HIPAA (Health Insurance Portability and Accountability Act) protects:
Hospital billing codes
Patient health information and privacy
Doctors from malpractice lawsuits
Insurance company profits
Hospice care focuses on:
Emergency care for trauma patients
Preventive care for healthy patients
Special care for patients near the end of life, focusing on comfort rather than cure
Rehabilitation after surgery
Inpatient Services refer to:
Care given when a patient is admitted to a hospital overnight or longer
Care at a clinic without staying overnight
Services denied by insurance
A doctor’s outpatient visit
An Insurance Premium is:
A fixed amount at each visit
The money you pay each month for health insurance
The amount paid before insurance starts covering
The maximum insurance will pay
Medicaid is:
A government program for low-income individuals and families
A type of flexible spending account
Insurance that pays only for prescriptions
Insurance coverage for job-related injuries
Medicare is:
A private insurance plan for dependents
A government program that provides health insurance for people age 65+ or with certain disabilities
A law that requires preauthorization
Coverage provided through an employer
Medicare Part A helps pay for:
Prescription drugs
Doctor visits and outpatient care
Hospital care
Medical equipment like wheelchairs
Medicare Part B covers:
Doctor visits, outpatient care, and medical supplies
Hospital stays only
Prescription drug coverage
Dependent family members
Medicare Part D helps pay for:
Prescription drugs
Durable medical equipment
Hospital care
Family leave coverage
A Non-Covered Charge is:
A service that insurance will not pay for
A fee for filing a claim
A reduced cost of prescription drugs
A copayment at a doctor visit
A Non-Network Provider is:
A doctor or hospital that is not part of your insurance plan
An insurance agent
A dependent covered under insurance
A government-sponsored hospital
Open Enrollment is:
The time of year when you can sign up for or make changes to your health insurance plan
A special account for pre-tax medical spending
A grievance filed against insurance
Coverage for dependents under age 26
An Out-of-Pocket Cost is:
The monthly premium you pay
The money a patient must pay themselves, not covered by insurance
The fixed amount at each visit
A bill denied by insurance
Outpatient Services are:
Care given at a clinic or hospital without staying overnight
Emergency care requiring hospitalization
Long-term nursing home care
A procedure requiring a deductible payment
Preauthorization (Pre-Approval) means:
Insurance company approval needed before certain medical services or procedures
A grievance filed after denial of coverage
A list of covered drugs
Payment of the deductible
A Pre-Existing Condition is:
A health problem a patient already had before getting a new insurance plan
A diagnosis made during a hospital stay
An appeal filed by a patient
An emergency condition requiring immediate care
A Prescription Drug is:
Medicine that can only be given with a doctor’s order
Any over-the-counter medicine
A drug covered only by Medicare
An elective medication
A Qualifying Life Event allows you to:
Change insurance coverage outside of open enrollment
Appeal an insurance denial
File a grievance against a provider
Apply for Medicaid automatically
Urgent Care clinics provide:
Long-term treatment for chronic illness
Care for health problems that are not life-threatening but need quick treatment
Emergency trauma care only
Hospice services
Workers’ Compensation is:
A savings account for medical expenses
Insurance that covers employees who are injured on the job
A law that protects patient information
A special government plan for retirees
The purpose of CPT Codes is to:
File patient grievances
Describe medical services and procedures for billing
Provide hospital billing codes
Track insurance premiums
