Midterm Part 1 Flashcards
Which type of HMO contracts health services that are delivered to subscribers by physicians who remain in their own office setting?
A. Independent practice Association
B. Preferred provider organization
C. Point-off-service plan
D. Triple-option plan
Independent practice Association
How many times a year can someone participating in Medicare part D change plans?
A. Once a year
B. Can not change
C. Twice a year
D. Every 6 months
Once a year
Which insurance claim is submitted to receive reimbursement under Medicare Part A?
A. CMS-1500
B. CMS-1500 or UB-04
C. UB-04
D. CMS-1500 and UB-04
UB-04
Nonprofit corporations are charitable, educational, civic, or humanitarian organizations whose profits are __________.
A. Paid to the federal government as taxes
B. Returned to nonprofit corporation
C. Sent to beneficiaries who paid premiums
D. Distributed to shareholders and officers
Returned to nonprofit corporation
Edna has a PPO plan with a $25 copay for primary physicians and a $50 copay for specialists. She also has a $3500 deductible and a 20% coinsurance up to $5000. In the past year she had knee arthroscopic surgery in March ($1000) and a colonoscopy in May ($950), where it was determined she had Stage 1 colon cancer. Starting in June, she will visit her gastroenterologist every month and her oncologist every 2 weeks. Edna’s cost for her chemotherapy infusions is $1250 each; she has a treatment every two weeks starting in June. How much does Edna pay in copayments for her gastroenterology and oncology appointments in September?
A. $100
B. $250
C. $300
D. $150
$150
TRUE/FALSE: The patient and the guarantor are always the same person.
False
In regards to healthcare insurance, the percentage that the guarantor pays is called the _________.
A. Copayment
B. Coinsurance
C. Contractual disallowance
D. Deductible
Coinsurance
When a provider accepts assignments this means that the __________.
A. Patient authorizes payment to be made directly to the provider
B. Provider accepts as payment in full whatever the payer reimburses
C. Balance billing is allowed on patient accounts, but at a limited rate
D. Participating provider receives a fee for a service reimbursement
Provider accepts as payment in full whatever the payer reimburses
Which is associated with the “last resort” health insurance for individuals who cannot obtain coverage due to a serious medical condition?
A. Association health insurance
B. Managed care
C. High-risk pool
D. Indemnity insurance
High-risk pool
Do you have to apply for Medicare on the exact day that you turn 65?
A. No
B. Yes
No
