Midterm Part 2 Flashcards
Which program includes managed care and private fee-for-service plans that provide contracted care to Medicare patients?
A. Medicare Part B
B. Medicare Part C
C. Medicare Part D
D. Medicare Part A
Medicare Part C
Which of the following is a method of reimbursement based on charges calculated after the delivery of healthcare service?
A. Capitated payment
B. Retrospective payment
C. Episode of care payment
D. Prospective payment
Retrospective payment
The amount charged for medical insurance policy is called the __________.
A. Deductible
B. Premium
C. Claim
D. Fee schedule
Premium
Which program helps individuals whose assets are not low enough to qualify them for Medicaid by requiring states to pay their Medicare Part A and B premiums, deductibles, and coinsurance amounts?
A. Qualifying individuals
B. Specified low-income Medicare beneficiary
C. Qualified Medicare beneficiary program
D. Program disabled working individual
Qualified Medicare beneficiary program
Medicare beneficiaries can also obtain supplemental insurance to help cover costs not reimbursed by the original Medicare plan. This type of coverage is called _________.
A. Medigap
B. PACE
C. Medicare PLUS
D. Medicaid
Medigap
In 2020 Medicare Part B patients pay an annual deductible of _______.
A. $135
B. $198
C. $147
D. $114
$198
The patient must pay $500 out of her own pocket before her insurance company will begin to reimburse for medical expenses. She is also responsible for 20% of the bill for medical services. The 20% is the __________.
A. Deductible
B. Premium
C. Coinsurance
D. Charge
Coinsurance
Which of the following is true about Medicare Part B insurance?
A. It is a voluntary supplementary insurance
B. It covers all acute care hospitalization costs
C. It is automatically provided to every senior citizen over the age of 65 or older
D. It covers all skilled nursing care costs
It is a voluntary supplementary insurance
Which is created when a number of people are grouped for insurance purposes and the cost of health care coverage is determined by employees’ health status, age, sex, and occupation?
A. Risk pool
B. Self-referral
C. Managed care
D. Cafeteria plan
Risk pool
The primary care provider (PCP) is responsible for _____________.
A. Denying all referrals to specialists and impatient hospital admissions
B. Being a gatekeeper to provide services at the highest possible cost
C. Supervising and coordinating health care services for enrollees
D. Providing nonessential health care services to all patients
Supervising and coordinating health care services for enrollees
