Comprehensive Health Insurance Exam

Front 1

Which of the following statements is TRUE according to the "gatekeeper" concept?

a. The primary care physician or another health care worker is the case manager for the patient.

b. The insurance underwriter chooses the patient who received coverage.

c. The medical coder chooses the charts that will be coded.

d. The physician chooses the cases that generate higher reimbursement.

Back 1

a. The primary care physician or another health care worker is the case manager for the patient.

Front 2

What is the Healthcare Effectiveness Data and Information Set (HEDIS)?

a. A set of performance measures used to compare managed care plan quality.

b. A statistical report used for hospital contingency analysis.

c. A numerical data set used for healthcare performance analysis.

d. A set of alphabetic measurements for hospital comparison.

Back 2

a. A set of performance measures used to compare managed care plan quality.

Front 3

Medicare Part A covers inpatient hospital care and long term care when these services:

a. are billed as supplemental outpatient services.

b. exceed the average length of stay.

c. are medically necessary.

d. reduce the need for additional nusing care.

Back 3

c. are medically necessary.

Front 4

A provider is classified as a/an:

a. beneficiary that provides information for insurance coverage.

b. coder who provides medical record data.

c. biller who submits claims to insurance carriers.

d. individual or group of individuals that provide a health care service.

Back 4

d. individual or group of individuals that provide a health care service.

Front 5

Medicare Part D covers:

a. occupational therapy visits.

b. hospital inpatient stays.

c. physician surgeries.

d. prescription drugs.

Back 5

d. prescription drugs.

Front 6

The term "active duty" would apply to:

a. nurses who person duties while active in a specific radius.

b. patients covered under TRICARE.

c. physicians who perform duties on a 24 hour rotation.

d. patients covered under Medicare Part D.

Back 6

b. patients covered under TRICARE.

Front 7

An organization that provides pain relief and supportive care to terminally ill patients is called a/an:

a. inpatient hospital.

b. hospice.

c. nursing home.

d. ambulatory surgery center.

Back 7

b. hospice.

Front 8

Businesses that provide support services to individual physicians are called:

a. management service organizations.

b. physician hospital organizations.

c. group practices without walls.

d. medical foundations.

Back 8

a. management service organizations.

Front 9

An HMO is an example of a/an _____ plan.

a. occupational rehabilitation therapy

b. supplemental physical therapy

c. managed care

d. prescription based

Back 9

c. managed care

Front 10

A 67 year old patient is receiving home health care for physical therapy. A medical coder would submit the bill under:

a. Medigap

b. Medicare Part D

c. Medicare Part A

d. Medicare Part C

Back 10

c. Medicare Part A

Front 11

If you need to see an orthopedic specialist for your broken leg, but are required to check with your primary care physician first, you most likely belong to a/an:

a. POS

b. HMO

c. EPO

d. PPO

Back 11

b. HMO

Front 12

Healthcare providers who organize to treat Medicare patients are called _____ organizations.

a. managed care

b. geriatric care

c. independent care

d. accountable care

Back 12

d. accountable care

Front 13

Officer Browner is an active member of the Air Force. He visited the emergency room for treatment of a wrist fracture. The coder is billing for the emergency room visit and the treatment of the fracture. The coder will most likely submit the claim to:

a. SCHIP

b. CHAMPVA

c. CHAMPUS

d. TRICARE

Back 13

d. TRICARE

Front 14

What is indemnity?

a. A provision of security against hurt, loss, or damage with specific cash payments.

b. The amount that the insured pays out of pocket.

c. A portion of an insured loss paid by the insured.

d. About 70% of the patients payment policy.

Back 14

a. A provision of security against hurt, loss, or damage with specific cash payments.

Front 15

Medicare Part B is classified as:

a. supplemental coverage for physical therapy.

b. additional coverage for dependents under the age of 18.

c. supplemental medical insurance coverage.

d. additional insurance for elderly patients over the age of 75.

Back 15

c. supplemental medical insurance coverage.

Front 16

Independent (or individual) practice associations (IPAs) are based on:

a. PPO service contracts with groups of hospitals.

b. IPO policy benefits established for new patients.

c. HMO service contracts with organized groups of physicians.

d. MCO contracts established with physicians.

Back 16

c. HMO service contracts with organized groups of physicians.

Front 17

Private health insurance is also called:

a. Schip Third Party Payor Insurance

b. individual insurance or non-group insurance.

c. VA Administration Insurance

d. Medicode insurance

Back 17

b. individual insurance or non-group insurance.

Front 18

Who is eligible for CHAMPVA benefits?

a. Dependents of active duty military personnel.

b. Military families not living in the US.

c. Dependents and survivors of permanently and totally disabled veterans.

d. Spouses of military personnel in combat zones.

Back 18

c. Dependents and survivors of permanently and totally disabled veterans.

Front 19

Employer groups that are trying to control costs might develop a/an:

a. accountable care organization (ACO)

b. integrated delivery system (IDS)

c. health maintenance organization (HMO)

d. exclusive provider organization (EPO)

Back 19

d. exclusive provider organization (EPO)

Front 20

Nonprofit organizations used for physician management are called:

a. medical foundations

b. health care management organizations

c. medical trade groups

d. health care fraternal organizations

Back 20

a. medical foundations