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MA > Insurance > Flashcards

Insurance Flashcards

1
Q

When did group health insurance become a commonly accepted employment benefit?

A

After World War II

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2
Q

Does Medicare cover all health care expenses?

A

No

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3
Q

All claims in the United States will eventually be filed…

A

Eectronically

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4
Q

A small fee paid at the time of service

A

Co-pay

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5
Q

Expenses not covered by an insurance company

A

Exclusions

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6
Q

Is it the responsibility of the MA to interpret the pt’s insurance policy or extent of coverage?

A

No

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7
Q

Some insurers will not pay a claim unless it is filed within how long?

A

Within 6 months from date of service

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8
Q

Originally developed by congress to pay medical insurance claims under Medicare

A

The concept of usual, customary, and reasonable fees (UCR)

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9
Q

Most common insurance claim form

A

The Health Care Financing Administration (HCFA)

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10
Q

Should you fold the HCFA-1500 form for OCR before mailing?

A

No

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11
Q

Is disability insurance less expensive than life, home, or automobile insurance?

A

No

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12
Q

Federally aided program for medical care for certain low income idviduals

A

Medicaid

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13
Q

Older or disabled pts who have Medicare and cannot pay the difference between the bill and the Medicare payment qualify for…

A

Medi/Medi

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14
Q

Is blue cross/blue shield one large corporation?

A

No

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15
Q

What benefit policy provides payment in full for all covered services?

A

Blue cross/blue shield

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16
Q

Do medical practices have to cover worker’s comp cases?

A

No

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17
Q

Does a patient belonging to an HMO need pre-approval or with for inpatient surgery from the pcp or HMO?

A

Yes

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18
Q

Does Medicare encourage claims to be filed electronically to save time?

A

Yes

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19
Q

When did the first insurance plans begin?

A

During the civil war

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20
Q

First type of insurance created

A

Accident insurance

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21
Q

The first health insurance was created to cover…

A

Lost income because of disability

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22
Q

When did the first group policy giving comprehensive benefits emerge?

A

1847

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23
Q

The prepaid concept became the foundation for what insurance?

A

Blue cross

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24
Q

Who’s goal was to make health insurance accessible to as many people as possible?

A

Blue cross/blue shield

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25
Q

The first modern group health insurance became an employment benefit because…

A

A group of school teachers in Dallas joined forces and requested it

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26
Q

The first national health insurance for Americans age 65 and older

A

Medicare

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27
Q

The underlying principle of all types of insurance

A

The law or probability

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28
Q

Term meaning that the insured pays or shares part of the medical bill with the insurance company, usually according to a fixed percentage

A

Co-insurance

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29
Q

Term referring to the amount required to be paid

A

Deductible

30
Q

Many pts carry supplemental medical coverage which is also…

A

Major medical insurance

31
Q

Is there a deductible is part a Medicare?

A

Yes

32
Q

Participation in the plan is voluntary, a monthly premium must be paid, the pt must pay a deductible are all true statements for which part of Medicare?

A

Part b

33
Q

Is the beneficiary’s address recorded on the ID card?

A

No

34
Q

Are routine physical exams and prescriptions for eyeglasses and hearing aids covered in Medicare part b?

A

No

35
Q

The most common reason for Medicare claim forms being rejected

A

Incomplete information and errors

36
Q

The federal government participated in a plan for the indigent known as…

A

Medicaid

37
Q

A program of medical care for the needy provided by the title XIX of the social security amendment of 1965

A

Medicaid

38
Q

Are the following true of blue cross/blue shield?

  • pay no benefits
  • operate at a continual loss
  • are considered as charitable institutions
A

No

39
Q

Under a law passed in 1956, who provides medical and hospital care for all dependents of members of the armed services on active duty, all retired military personnel and their dependents, and members of the coastguard?

A

Tricare formerly champus

40
Q

At what age does the tricare beneficiary lose eligibility?

A

65

41
Q

Is it automatic to lose tricare benefits at age 65?

A

Yes

42
Q

An insurance contract written for a company for its employees

A

Group coverage

43
Q

A pt 68yo is most likely covered by what insurance?

A

Medicare

44
Q

Medicare pays what percent?

A

80

45
Q

To establish eligibility for Medicaid you must check…

A

Current ID, policy number, and ssn

46
Q

Persons who are unable to pay for medical care or who have dependent children may apply for…

A

Medicaid

47
Q

What kind of insurance provided medical care for job related accidents or illness?

A

Workers comp

48
Q

What type of insurance provides income when the insured is unable to work due to illness or injury?

A

Disability

49
Q

The physician or supplier giving medical care or services

A

Provider

50
Q

Person who carries the medical insurance

A

Subscriber

51
Q

The word indicating the date medical insurance coverage begins

A

Effective

52
Q

Insurance that provides weekly or monthly cash benefits to employed policy holders who become unable to work because of accident or illness

A

Loss of income protection

53
Q

Catastrophic coverage is referred to as…

A

Major medical insurance

54
Q

Hospital insurance in included in which part of Medicare?

A

A

55
Q

Blue shield makes direct payments to…

A

Physician members

56
Q

A bed patient in a hospital who is entitled to Medicare benefits is covered for up to…

A

90 hospital days for each benefits period

57
Q

Witching 48 hrs after a physician has seen a workmans company pt for the first time, the report is typed in…

A

Quadruplicate

58
Q

A bill is never sent to the pt in which type of case

A

Worker’s comp

59
Q

The amount charged for a medical insurance policy

A

Premium

60
Q

Non-duplication of benefits is also known as…

A

Coordination of benefits

61
Q

Blue cross offers which method of reimbursement?

A

Fee for service

62
Q

In most cases, the insurer pays an annual cost or what for health care insurance?

A

Premium

63
Q

A fixed dollar amount the subscriber must pay or “meet” each year before the insurer begins to cover expenses

A

Deductible

64
Q

A small fee at the time of service that some medical practices may require the subscriber to pay

A

Co-pay

65
Q

The Physicians’ Current Procedural Terminology (CPT) manual provides…

A

Procedure and diagnosis codes

66
Q

In a typical medical practice, insurance claims are filed…

A

7 to 10 business days from the date of service

67
Q

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…

A

Denied as a billing error because the treatment was not medically necessary based on diagnosis

68
Q

When an insurance claims department compared the fee the doctor charges with the benefits provided by the pt’s health insurance

A

Review for allowable benefits

69
Q

What the pt owes after the insurance company has paid

A

Subscriber liability

70
Q

The most appropriate response from an MA when a patient calls the medical practice questioning why an insurance claim was rejected

A

Check the explanation of benefits form

71
Q

The average fee a physician charged for a service or procedure

A

Usual fee

MA (12 decks)

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