Download Medical Practices – Chapter 1 Quiz: Foundations of Healthcare. and more Exams Insurance law in PDF only on Docsity!
Medical Practices – Chapter 1 Quiz:
Foundations of Healthcare.
- Which of the following is an example of a private-sector payer? - << Correct Answer >>✅✅ insurance company
- A patient ledger records: - << Correct Answer >>✅✅ the patient's financial transactions
- Imagine you are a medical insurance specialist; illustrate the impact your ability to prepare accurate, timely claims can have on the practice. - << Correct Answer >>✅✅ preparing accurate and timely claims generally leads to full and timely reimbursement from the health plan
- Practice management programs may be used for: - << Correct Answer
✅✅ scheduling appointments, financial record keeping, and billing
- The statement that "coding professionals should not change codes.. .to increase billings" is an example of: - << Correct Answer >>✅✅ professional ethics
- Courteous treatment of patients who visit the medical practice is an example of medical: - << Correct Answer >>✅✅ etiquette
- What attributes should a medical insurance specialist possess to help lead to success? - << Correct Answer >>✅✅ professional appearance, practicing courtesy, good attendance, and attention to detail
- Pick the most accurate definition of certification. - << Correct Answer
✅✅ recognition of a superior level of skill by an official organization
- What is typically required of professional organizations? - << Correct Answer >>✅✅ continuing education sessions
10.Examine the list of services and determine which one would most likely be considered a non covered service - << Correct Answer >>✅✅ employment-related injuries
11.What kind of medical services are annual physical examinations and routine screening procedures? - << Correct Answer >>✅✅ preventive
12.Under an insurance contract, the patient is the first party and the physician is the second party. Who is third party? - << Correct Answer
✅✅ insurance plan
13.In what ways can insurance policies be written? - << Correct Answer
✅✅ an individual or group
14.Determine which of the following entities is not considered a provider. - << Correct Answer >>✅✅ insurance companies
15.Dependents of a policyholder may include his/her: - << Correct Answer
✅✅ spouse and children
24.Under a fee-for-service plan, the third-party payer makes a payment: - << Correct Answer >>✅✅ after medical services are provided
25.Calculate the amount of money a patient would owe for a covered service costing $1,200 if their indemnity policy has a coinsurance rate of 75-25, and they have already met their deductible. - << Correct Answer
✅✅ $
26.Calculate the amount of money a patient would owe for a noncovered service costing $900 if their indemnity policy has a coinsurance rate of 80- 20, and they have already met their deductible. - << Correct Answer
✅✅ $
27.Calculate the amount of money a patient would owe for a covered service costing $1,800 if their indemnity policy has a $400 deductible (which has not been met) and their coinsurance rate is 80-20. - << Correct Answer
✅✅ $
28.When is a deductible paid? - << Correct Answer >>✅✅ before benefits begin
29.How is coinsurance defined? - << Correct Answer >>✅✅ the percentage of each claim that the insured pays
30.What is a premium? - << Correct Answer >>✅✅ the periodic payment the insured is required to make to keep a policy in effect
31.Calculate the amount of money the insurance company would owe on a covered service costing $850 if there is a $500 deductible (which has not yet been met) and no coinsurance. - << Correct Answer >>✅✅ $
32.Identify the advantages offered to patients in managed care plans, as compared to indemnity insurance. - << Correct Answer >>✅✅ lower premiums,charges, and deductibles
33.Choose the entity(ies) that may form agreements with an MCO. - << Correct Answer >>✅✅ the patient and provider
34.Name a benefit a provider usually gets from participation with a health plan. - << Correct Answer >>✅✅ an increased number of patients
35.Healthcare claims report data to payers about __________ and __________. - << Correct Answer >>✅✅ the patient; the services provided by the physician
36.When the coinsurance rate is stated, which number, the first or the second, describes the insurance company's percentage? - << Correct Answer >>✅✅ first
37.In what format are healthcare claims sent? - << Correct Answer >>✅✅ Electronic and hard copy
38.What is the formula for calculating an insurance company payment in an indemnity plan? - << Correct Answer >>✅✅ charge - deductible - coinsurance
39.A capitated payment amount is called a - << Correct Answer >>✅✅ prospective payment
48.PPO members who use out-of-network providers may be subjected to: - << Correct Answer >>✅✅ higher copayments
49.Name the two components of a consumer-driven health plan (CDHP). - << Correct Answer >>✅✅ a health plan and a special "savings account"
50.Employers that offer health plans to employees without using an insurance carrier are: - << Correct Answer >>✅✅ self-funded (insured) health plans
