Midterm Part 6 Flashcards
Medicare lifetime reserve days, which total _______ days, are used once during a patient’s lifetime and are usually reserved for use during the patient’s final, terminal hospital day.
A. 30
B. 90
C. 120
D. 60
60
Which act allows employees to continue health care coverage beyond the benefit termination date?
A. Tax equity and Fiscal responsibility act of 1982
B. Health insurance portability and accountability act of 1996
C. Omnibus budget reconciliation act of 1981
D. Consolidated omnibus budget a reconciliation act of 1985
Consolidated omnibus budget a reconciliation act of 1985
Which includes health maintenance organizations and preferred provider organizations?
A. Indemnity insurance
B. Association health insurance
C. High-risk pool
D. Managed Care
Managed Care
Group health insurance is available through employers and other organizations, and all or part of the premium cost are paid by employers. Employer-based group health insurance ________.
A. Prohibits employer-limited plan options, such as prescription drug plan that covers a certain list of medications, which is called formulary
B. Requires exclusions for pre-existing conditions, which means the payer excludes all employees from coverage for pre-existing conditions
C. Excludes COBRA continuation coverage upon employee resignation or another qualifying event and last for 18 to 36 months, depending on the employee’s situation
D. Covers all employees, regardless of health status, and cannot be canceled if an employee becomes ill
Covers all employees, regardless of health status, and cannot be canceled if an employee becomes ill
Mr. Smith has Medicare part B coverage. He has been very ill over the past year. It is now January 1 and Mr. Smith is rushed to the hospital, where Dr. Haynes performs emergency gastric resection. Medicare is billed for $500 for the physicians part of the surgery and the doctor agrees to except assignment. The patient has not met his deductible since it is only January 1. What does the patient owe Dr. Haynes?
A. $302
B. $258.40
C. $241.60
D. $369
$258.40
Large employers who assume the financial risk for providing healthcare benefits to employees do not pay a fixed premium to a health insurance payer, but establish a trust fund (of employer and employee contributions) out of which claims are paid. The concept is called ______?
A. Self-insurance
B. Capitation
C. Managed care
D. Underwriting
Self-insurance
When the amount of payment is determined before the service is delivered, ________.
A. Retrospective
B. Fee-for-Service
C. Per diem
D. Prospective
Prospective
How many benefit periods are covered by hospital insurance during Medicare beneficiary’s lifetime?
A. Unlimited
B. None
C. One per year
D. Based on 90 day stay
Unlimited
Medicare part B pays for glaucoma screenings once every ______ months for Medicare recipients who are at high-risk.
A. 12 months
B. 18 months
C. 6 months
D. 3 months
12 months
Edna has a PPO plan with a $25 copay for primary physicians and a $50 copay for specialist. 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 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. Would Edna still need to pay her office visit copayment even if she has met her deductible and coinsurance limits for the year?
A. Yes, but copayments are applied to the following year deductibles and coinsurances
B. No, Edna would not pay anything out-of-pocket after she meets her maximum
C. No, Edna would not pay anything out of pocket after she meets maximum coinsurance
D. Yes, copayments do not add or subtract from deductibles and/or coinsurances
Yes, copayments do not add or subtract from deductibles and/or coinsurances
