NEW
Font size
WorksheetsChapter 3: Insurance Terms Quiz
Total questions: 61
Worksheet time: 31mins
Health insurance was first offered in the United States when?
1847
1929
1943
1965
What was the first type of insurance created?
accident
basic medical
dental
vision
The first health insurance was created to cover:
basic medical expenses
the frequent railroad and steamboat disasters of the era
lost income because of a disability
as many people as possible under group coverage
The first group coverage emerged in:
1929
1943
1847
1965
The prepaid concept became the foundation for________ insurance
Aetna
Prudential
State farm
Blue cross
The goal of Blue Cross / Blue Shield was to:
cover only the frequent disasters of the era
cover lost income because of a disability
make health insurance accessible to as many
negotiate for fringe benefits of employment
Health insurance first became an employment benefit because:
a group of schoolteachers in Dallas, Texas joined forces and requested it
a World War II and a 'hold-the-line' wage freeze
there was a financial need to keep health care costs down
there was no coverage for the elderly population who retired
The first national health insurance for Americans age 65 and older is:
Medicaid
Medicare
Disability insurance
Liability insurance
Who most frequently files insurance claims and handles insurers' payments to a medical practice?
The patient
The nurse
The medical assistant
The physician
The authorization for an insurance carrier to pay the physician or practice directly is the:
Co-payment
provider of medical services
assignment of benefits
health insurance provider
The person whose name the insurance is carried in is called the:
Carrier
subscriber
Coinsurance
Provider
In most cases, the insurer pays an annual cost or _______ for health care insurance
coinsurance
deductible
premium
coinsurance
A fixed dollar amount the subscriber must pay or "meet" each year before the insurer begins to cover expenses is the:
co-payment
deductible
premium
coinsurance
Some medical practices may require the subscriber to pay a small fee at the time of service, called a/an:
co-payment
exclusion
deductible
coinsurance
The Physicians' Current Procedural Terminology (CPT) manual provides:
comprehensive information on prescription medications
procedure codes
descriptions of common medical procedures
a fee schedule for medical services and procedures
In a typical medical practice, insurance claims are filed:
7 to 10 business days from the date of service
9 months after the service is rendered
one year from the date of service
at any time
The most likely outcome of a submitted insurance claim with a diagnosis code of a sore throat and a treatment code indicating a cast for a broken leg would be:
coverage at 100 percent
the fee for service would be applied toward the patient's deductible
denied as a billing error because the treatment was not medically necessary based on diagnosis
the patient may have to pay a coinsurance after the deductible is met
When an insurance claims department compares the fee the doctor charges with the benefits provided by the patient's health insurance, it is called the:
payment of benefits
review of medical necessity
review for allowable benefits
explanation of benefits
Which of the following is what the patient owes after the insurance company has paid?
Premium
Exclusion
Subscribe Liability
Comorbidity
The most appropriate response from a medical assistant when a patient calls the medical practice questioning why an insurance claim was rejected is:
"I will ask your physician" form
"The service must not be covered"
"Check your explanation of benefits"
"Is your deductible met?"
The average fee a physician charges for a service or procedure is the ______ fee.
customary
reasonable
prevailing
usual
The generally accepted fee a physician charges for an exceptionally difficult or complicated service is the ________ fee
usual
customary
prevailing
reasonable
The need for a flexible fee schedule for medical services that can reflect regional cost differences and differences in medical education and specialty is facilitated by:
DRG's
the UCR system
PROS's
HMO's
The UCR rate includes the fee submitted, the provider's usual fee profile, and:
the patient prognosis
capitation
the customary profile for the area
Comorbidity
The average fee charged for a procedure by similar doctors in the same region or the ninetieth percentile of the fees charged for the procedure by similar doctors in the same area is the ______ fee.
Usual
Customary
Reasonable
Accepted
You should do which of the following when filling out the HCFA-1500 for optical character reader (OCR) scanning?
enter all data by hand
use all uppercase (CAPITAL) letters for all entries
Use colored ink
use the abbreviation N/A to indicate that a field is not applicable
Groups of procedures or tests related directly to a given diagnosis that are likely to be covered by an insurer are:
diagnosis-related groups
peer-review organizations
health maintenance organizations
Blue Cross/Blue Shield
The prevailing fee for that service or procedure in the geographic region is the ________fee.
Usual
Customary
Reasonable
Accepted
The law that sets reimbursement based on diagnosis-related groups is the:
Federal Insurance Contributions Act
Tax Equity and Fiscal Responsibility Act of 1982
Social Security Amendment Act
Medicare Catastrophic Coverage Act
Diagnosis-related groups are classified first by
medical code
surgical code
discharge status
major diagnostic category
Comorbidity is:
prediction of the probable course of a disease in an individual and the chances of recovery
a preexisting condition
whether the patient qualifies for service or procedures
a statement of the patient's condition
The groups of health care professionals who check hospital diagnosis, quality of services, and patient admissions and discharges related to government-funded health care within each state are called:
peer review organizations
diagnosis-related groups
health maintenance organizations
Which of the following types of insurance covers injuries caused by the insured or that occurred on the insurer's property?
medical
liability
Medicare
Disability
Under Medicare Part B, patients are not permitted to:
remain in the hospital for more than 90 days
receive medical care at home
purchase private insurance
submit their own claims for reimbursement
A patient who has been hospitalized up to 90 days for each benefit period is covered under
Medicare Part A
TRICARE
CHAMPVA
Medicare Part B
A benefit period for Medicare begins the day a patient goes into the hospital and ends when that patient has not been hospitalized for _____ days.
30
60
90
120
Which of the following is a characteristic of Medicaid?
it is an insurance program
approved health benefits to people 65 and older
pays for 12 office visits per year
provides health benefits to patients who have a serious long-term disability
Patients under the age of 65 who are blind or widowed or who have serious long-term disabilities, such as chronic joint pain ______ or , may also be entitled to Medicare
kidney failure
asthma
stomach ulcers
pneumonia
Which of the following is a Medicare requirement for home health care?
the patient must be able to leave home
the family can request any medical service without the authorization of the physician
the patient must be in need of physical therapy, speech therapy, or skilled nursing care
the Medicare services provided must be full time
Which of the following are included in Medicare benefits for respite care?
the patient must be terminally ill with 2 years or less to live
Medicare has no respite care benefits
the terminally ill patient is moved to a care facility for the respite
Medicare provides a respite for the terminally ill patient
An organization that provides pain relief to terminally ill patients and supports these patients and their families is a:
respite
comorbidity
prognosis
hospice
Which of the following applies to a physician who has an accepting assignment with Medicaid?
the physician can bill the patient for Medicaid co-pays
the physician may see Medicaid patients as a last resort when he does not have enough patients with insurance
if the physician's fee is higher than the Medicaid payment, the patient is billed for the difference
the physician does not have to agree to accept the established Medicaid payment for covered services
The appropriate way to file a Medicare form for a patient who cannot sign a claim form is to:
have the physician sign the claim form
submit the patient's signature on a Lifetime Beneficiary Claim Authorization and Information Release
ask a family member to sign the claim form
submit the claim form with no signature
The amount Medicare pays the physician or health care provider after the $100 annual deductible is met is:
20%
50%
80%
100%
Medicare's fee schedule regulating payment for all services and procedures provided by doctors is based on:
HCFA's Common Procedures Coding System (HCPCS)
the geographic practice cost index (GPI) called 'gypsy', which takes regional differences into account
Medigap, to reduce the gap in coverage
the fact that patients may now be billed for any services not covered by Medicare
Which of the following is an accurate statement about participating versus non-participating doctors?
for participating doctors, Medicare sets what is called 'non par fee' schedule
Medicare sets 'par fee' schedules for doctors who do not accept Medicare assignments
under the 'par fee' schedule, the patient pays the practice, and the patient receives reimbursement for Medicare
a 'par fee' schedule outlines the fees a participating doctor can charge
Which of the following is applicable when filing a Medicaid claim?
allow a 2-year time limit on claim submissions
the patient does not need to prove eligibility for benefits
avoid treating the patient as inferior to patients with private insurance
submit a claim even if the patient cannot prove Medicaid membership
Which statement is true about TRICARE?
the person in uniform is not eligible for paid medical care until he retires
TRICARE is a health insurance plan
expenses of the families of veterans with total, permanent, service connected disabilities are
covered
surviving spouses and dependent children of veterans who died in the line of duty are covered for benefits
TRICARE covers which of the following services
retirement homes
hearing examinations
magnetic resonance imaging (MRI)
eyeglasses
TRICARE (formerly CHAMPUS) was created because:
the Korean War created a need for medical services for families of military personnel
services such as eyeglasses and hearing examinations were not previously covered for military personnel
of a health benefit need for low income, blind, disabled patients, families receiving aid to dependent children, foster children, and children with birth defects
health insurance was inadequate for citizens 65 years of age or
Which of the following applies to payment of TRICARE or CHAMPVA benefits?
HCFA-1500
verification of eligibility is not required
emergency and non-emergency inpatient care does not need authorization
a patient who lives 40 miles or more from a military base does not need advance authorization
Blue Cross/Blue Shield (BCBS) have the reserved right of
cancellation of a patient's policy because of poor health or greater-than-average benefit payment
no conversion to individual coverage
obtaining the state insurance commissioner's approval for statewide rate or benefit changes
denial of transfer of benefit from state to state
Medicare encourages all practices to file claims electronically because:
the process saves time
the process is required by law
the practice will receive larger payments
such claims cannot be rejected
Which of the following is included under Worker's Compensation insurance?
rehabilitation costs are covered to return an employee to work
a monthly amount paid to the patient for a temporary disability
only selected medical expenses are covered and no inpatient expenses are covered
there are no death benefits
A characteristic of a health maintenance organization (HMO) is:
focusing on medical procedures and services and not on wellness or preventive care
requiring subscribers to complete paperwork and file claims for routine procedures and services
physicians enrolling in an HMO are called participating physicians
discouraging routine annual physical examinations
Most HMO co-payments are:
a set amount
a percentage of the medical bill
paid by an employer
the unpaid balance
The correct procedure an HMO patient must follow for coverage when she discovers a breast lump is to make an appointment with:
a surgeon
her primary care physician
a gynecologist
an oncologist
A husband and wife, both employed and have work sponsored insurance plans that cover each other and their three children. Which insurance plan is the primary payer?
the insurance plan of the person whose birthday comes first in the calendar year
the wife's insurance plan, because it has the most comprehensive coverage
the husband's insurance plan, because he makes more money
whichever the husband and wife want to declare as primary
Electronic claims transmission (ECT) includes:
more paperwork
a greater amount of time to process claims
instant identification on the screen of errors and omissions that could cause a claim to be rejected
a 30-day turnaround time from submission to payment on error free claims for most insurance companies
Which of the following is correct regarding electronic claims submission?
an in house computer nputer system can communicate with an insurer's system
a time share computer system sends insurance information directly to an insurance company's computers
a batch system computer enters insurance information to be stored, retrieved, edited, or printed out as needed
an ECT system is quick, uses no paper, and permits fewer mistakes and omissions than other methods of transmitting claims
An appropriate approach to maintain patient confidentiality on the computer is to:
change your password every 90 days
make sure a co-worker knows knows your password
keep magnetic computer disks or tapes on top of your desk
allow former employees to keep their passwords
