Ch 6: True and False

Question 1

T/F: With fee-for-service plans, patients can choose any physician they want and change physicians at any time.

Answer 1

True

Question 2

T/F: A third-party payer is any organization that provides payment for specified coverage provided under a health plan.

Answer 2

True

Question 3

T/F: Group insurance is generally more expensive because it covers more individuals.

Answer 3

False

Question 4

T/F: BCBS offers only fee-for-service plans.

Answer 4

False

Question 5

T/F: With FFS insurance, the policyholder controls the choice of physician and facility.

Answer 5

True

Question 6

T/F: FFS plans all have the same deductible amount.

Answer 6

False

Question 7

T/F: “Reasonable and customary” is a term used to refer to the commonly charged or prevailing fees for health services within a geographical area.

Answer 7

True

Question 8

T/F: Commercial health insurance is standard in price and the kinds of benefits that the policy covers.

Answer 8

False

Question 9

T/F: Most organizations that are self-insured are large entities, which can draw from hundreds or thousands of enrollees.

Answer 9

True

Question 10

T/F: A health savings account (HSA) is a tax-advantage account in which money can be set aside to pay for future medical expenses.

Answer 10

True

Question 11

T/F: Blue Cross policies cover inpatient care; Blue Shield covers physicians’ services.

Answer 11

False

Question 12

T/F: A high-deductable health plan (HDHP) is a health insurance plan with lower premiums and higher deductibles than a traditional health plan.

Answer 12

True

Question 13

T/F: If an individual belongs to a BlueCard PPO, the initials PPO appear inside a blue globe.

Answer 13

False

Question 14

T/F: Blue Cross and Blue Shield organizations are no longer governed at a national level, and each has its own specific guidelines for completing the CMS-1500 claim form.

Answer 14

True

Question 15

T/F: It is important to consult all types of insurance plans for their specific guidelines to avoid claim delays and rejections.

Answer 15

True

Question 16

T/F: Normally, when husband and wife are covered under separate policies, primary coverage follows the patient.

Answer 16

True

Question 17

T/F: An explanation of benefits (EOB) is a document prepared by the carrier that gives details of how the claim was adjudicated.

Answer 17

True

Question 18

T/F: The time limit for filing claims is the same for all third-party payers - 1 year.

Answer 18

False

Question 19

T/F: Filing CMS-1500 paper claims for commercial carriers is much the same as with all other carriers.

Answer 19

True

Question 20

T/F: HIPAA mandates that all commercial claims be submitted electronically.

Answer 20

False

Question 21

T/F: Today, insurers are encouraged to structure their reimbursement models based on the quality and utility of care provided rather than the sheer volume of services.

Answer 21

True

Question 22

T/F: One objective of an Integrated Delivery System (IDS) is improving quality of care while lowering patient cost.

Answer 22

True

Question 23

T/F: A model of care in which a primary provider manages and coordinates the care of all elements of a patient’s health with a team of healthcare providers is called patient-centered facility care.

Answer 23

True

Question 24

T/F: Medicare fiscal intermediaries (FIs) and carriers are now more commonly referred to as Medicare administrative contractors (MACs).

Answer 24

True

Question 25

T/F: A consumer-directed health plan (CDHP) often involves pairing a high-deductible PPO plan with a tax-advantaged account, such as a health savings account (HSA).

Answer 25

True