Medical Insurance Flashcards
Coordination of benefits means:
A) the patient pays a specific amount of money for medial services before the insurance pays
B) one insurance plan will work with other insurance plans to determine how much each plan pays
C) there is a flat fee paid for each service
D) there is a deductible required by the patient before payment from the insurance made
E) each insurance company will pay an equal amount of the patient’s bill
B) One insurance plan will work with other insurance plans to determine how much each plan pays
The person who is covered by a benefits plan is:
A) employee
B) carrier
C) administrator
D) insured
D) insured
A person’s spouse or child who is covered under the benefits plan is called the:
A) group member B) coinsured C) primary care D) carrier E) dependent
E) dependent
The amount that will be paid by the insurance plan for each procedure or service is based on the:
A) coinsurance
B) capitation
C) deductible
D) fee schedule
D) fee schedule
A government-sponsored program that provides health benefits to low-income or indigent persons is:
A) CHAMPUS B) CHAMPVA C) Medicare D) Medicaid E) Blue cross and Blue shield
D) Medicaid
If a patient is diagnosed with a disease before the effective date of the insurance plan it is a(n):
A) pre-existing condition
B) crossover claim
C) exclusion
D) capitation
A) pre-existing condition
Medicare is A federal health insurance program for:
A) anyone over
B) disabled workers who are at least 50 years of age
C) blind individuals who are at least50 years of age
D) individuals 65 years of age or older who are retired and on Social Security
D) individual 65 years of age or older who are retired and on Social Security
Medicare part a provides coverage for:
A) clinical laboratory services B) physicians office services C) hospitalization D) physicians hospital services E) outpatient referral fee for a specialist
C) hospitalization
The process of determining whether a service or procedure is covered by the insurance provider is called:
A) coordination of benefits
B) Precertification
C) capitation
D) assignment of benefits
B) Precertification
The medical bills of spouses and children of veterans with total, permanent, service-connected disabilities are covered under:
A) Blue Cross B) HMO C) worker's Compensation D) HCFA E) CHAMPVA
E) CHAMPVA
The process of making payment to a provider based on a fixed amount per enrollee assigned to that provider regardless of services provided is: A) Exclusion B) deductible C) capitation D) predetermination
C) capitation
A group of physicians who review cases for appropriateness of hospitalizations and discharges is called:
A) relative value studies B) preferred provider organization C) Quality improvement organization D) third-party payer E) State medical Board
C) Quality improvement organization
Health maintenance organization is best described as:
A) A group of physicians who have a contract to provide services to participating patients for predetermined fee
B) independently practicing physicians providing services to patients covered under all types of insurance
C) A group of physicians who are partners in the same corporation
D) A group of physicians who specialize and wellness
A) A group of physicians who have a contract to provide services to participating patients for a predetermined fee
A database or list of charges for each procedure indicating the charge of the majority of physicians in a geographic area is referred to as:
A) utilization review B) usual, customary, and reasonable C) coordination of benefits D) explanation of benefits E) capitation
B) usual, customary, and reasonable or UCR
Medicare part B does not cover:
A) physician office visits
B) diagnostic laboratory services
C) hospitalization
D) outpatient x-rays
C) hospitalization
Part a of Medicare covers hospital charges and services except for the physician charges that are covered under part B
