Review Questions

  1. Which of the following was developed to cover the costs of catastrophic expenses from illness or injury?
    1. Medicaid insurance
    2. Medicare insurance
    3. Primary care
    4. Private insurance
    5. Major medical insurance
  2. Physicians and other health care professionals who contract with the insurance carrier to provide patient care are called
    1. preferred providers
    2. managed care organizations
    3. assignment of benefits
    4. primary care physician
    5. exclusive provider organization
  3. The process of using the number of members enrolled in a plan to determine salary of the physician is called
    1. basic insurance
    2. HMO
    3. capitation
    4. catchment
    5. CHAMPVA
  4. The dependents of active-duty personnel, retired personnel, dependents of retired personnel, and dependents of personnel who died while on active duty are covered by
    1. CHAMPVA
    2. TRICARE
    3. SSI
    4. EPO
    5. HMO
  5. In most states, the employer pays a premium to an insurance carrier for a policy known as
    1. workers’ compensation insurance
    2. private insurance
    3. TRICARE
    4. Medicaid
    5. Medicare
  6. The EOB document may include all the of the following EXCEPT
    1. allowed amounts
    2. coding updates
    3. deductible
    4. patient name
    5. payment responsibilities
  7. Medicare is a federal health insurance program for the following categories of people EXCEPT
    1. blind individuals
    2. disabled widows
    3. patients with end-stage renal disease
    4. people 65 years or older
    5. preschool children
  8. ICD-10-CM codes that may be assigned during an encounter that are not necessarily a diagnosis but are factors that may influence a patient’s health status are referred to as
    1. E&M codes
    2. E-codes
    3. Z-codes
    4. Volume I codes
    5. Volume II codes
  9. An agreement in which the health care provider is paid a fixed amount for each person in a specific contract within the practice, regardless of service provided, is called
    1. capitation
    2. fixed coverage
    3. total coverage
    4. universal coverage
    5. utilization review
  10. Inquiry with an insurance company into the maximum dollar amount that will be paid for a procedure is called an insurance
    1. coinsurance
    2. preauthorization
    3. precertification
    4. predetermination
    5. reimbursement