Insurance

Question 1

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

Answer 1

After World War II

Question 2

Does Medicare cover all health care expenses?

Answer 2

No

Question 3

All claims in the United States will eventually be filed…

Answer 3

Eectronically

Question 4

A small fee paid at the time of service

Answer 4

Co-pay

Question 5

Expenses not covered by an insurance company

Answer 5

Exclusions

Question 6

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

Answer 6

No

Question 7

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

Answer 7

Within 6 months from date of service

Question 8

Originally developed by congress to pay medical insurance claims under Medicare

Answer 8

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

Question 9

Most common insurance claim form

Answer 9

The Health Care Financing Administration (HCFA)

Question 10

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

Answer 10

No

Question 11

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

Answer 11

No

Question 12

Federally aided program for medical care for certain low income idviduals

Answer 12

Medicaid

Question 13

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

Answer 13

Medi/Medi

Question 14

Is blue cross/blue shield one large corporation?

Answer 14

No

Question 15

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

Answer 15

Blue cross/blue shield

Question 16

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

Answer 16

No

Question 17

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

Answer 17

Yes

Question 18

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

Answer 18

Yes

Question 19

When did the first insurance plans begin?

Answer 19

During the civil war

Question 20

First type of insurance created

Answer 20

Accident insurance

Question 21

The first health insurance was created to cover…

Answer 21

Lost income because of disability

Question 22

When did the first group policy giving comprehensive benefits emerge?

Answer 22

1847

Question 23

The prepaid concept became the foundation for what insurance?

Answer 23

Blue cross

Question 24

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

Answer 24

Blue cross/blue shield

Question 25

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

Answer 25

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

Question 26

The first national health insurance for Americans age 65 and older

Answer 26

Medicare

Question 27

The underlying principle of all types of insurance

Answer 27

The law or probability

Question 28

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

Answer 28

Co-insurance

Question 29

Term referring to the amount required to be paid

Answer 29

Deductible

Question 30

Many pts carry supplemental medical coverage which is also...

Answer 30

Major medical insurance

Question 31

Is there a deductible is part a Medicare?

Answer 31

Yes

Question 32

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?

Answer 32

Part b

Question 33

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

Answer 33

No

Question 34

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

Answer 34

No

Question 35

The most common reason for Medicare claim forms being rejected

Answer 35

Incomplete information and errors

Question 36

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

Answer 36

Medicaid

Question 37

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

Answer 37

Medicaid

Question 38

Are the following true of blue cross/blue shield? - pay no benefits - operate at a continual loss - are considered as charitable institutions

Answer 38

No

Question 39

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?

Answer 39

Tricare formerly champus

Question 40

At what age does the tricare beneficiary lose eligibility?

Answer 40

65

Question 41

Is it automatic to lose tricare benefits at age 65?

Answer 41

Yes

Question 42

An insurance contract written for a company for its employees

Answer 42

Group coverage

Question 43

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

Answer 43

Medicare

Question 44

Medicare pays what percent?

Answer 44

80

Question 45

To establish eligibility for Medicaid you must check...

Answer 45

Current ID, policy number, and ssn

Question 46

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

Answer 46

Medicaid

Question 47

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

Answer 47

Workers comp

Question 48

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

Answer 48

Disability

Question 49

The physician or supplier giving medical care or services

Answer 49

Provider

Question 50

Person who carries the medical insurance

Answer 50

Subscriber

Question 51

The word indicating the date medical insurance coverage begins

Answer 51

Effective

Question 52

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

Answer 52

Loss of income protection

Question 53

Catastrophic coverage is referred to as...

Answer 53

Major medical insurance

Question 54

Hospital insurance in included in which part of Medicare?

Answer 54

A

Question 55

Blue shield makes direct payments to...

Answer 55

Physician members

Question 56

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

Answer 56

90 hospital days for each benefits period

Question 57

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

Answer 57

Quadruplicate

Question 58

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

Answer 58

Worker’s comp

Question 59

The amount charged for a medical insurance policy

Answer 59

Premium

Question 60

Non-duplication of benefits is also known as...

Answer 60

Coordination of benefits

Question 61

Blue cross offers which method of reimbursement?

Answer 61

Fee for service

Question 62

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

Answer 62

Premium

Question 63

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

Answer 63

Deductible

Question 64

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

Answer 64

Co-pay

Question 65

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

Answer 65

Procedure and diagnosis codes

Question 66

In a typical medical practice, insurance claims are filed...

Answer 66

7 to 10 business days from the date of service

Question 67

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...

Answer 67

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

Question 68

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

Answer 68

Review for allowable benefits

Question 69

What the pt owes after the insurance company has paid

Answer 69

Subscriber liability

Question 70

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

Answer 70

Check the explanation of benefits form

Question 71

The average fee a physician charged for a service or procedure

Answer 71

Usual fee