Question 1

Identify the type of HMO cost-containment method that requires patients to obtain approval for services before they receive the treatment.

Accepted Answer

A)   restricting patients' choice of providers
B)   requiring preauthorization for services
C)   controlling drug costs
D)   cost-sharingE) B) and C)
F) A) and B)

Question 2

Health care claims report data to payers about __________ and __________.

Accepted Answer

A)   the physician; the services provided by the physician
B)   the patient; the services provided by the physician
C)   the patient; the physician's income taxes
D)   the service; the deductibleE) A) and C)
F) B) and C)

Question 3

Calculate the amount of money the insurance company would owe on a covered service costing $850 if there is a $500 deductible (which has not yet been met)  and no coinsurance.

Accepted Answer

A)   $0
B)   $500
C)   $350
D)   $150E) B) and C)
F) None of the above

Question 4

Name the two components of a consumer-driven health plan (CDHP) .

Accepted Answer

A)   a health plan and a special "savings account"
B)   a health plan and a gatekeeper
C)   a gatekeeper and a formulary
D)   a gatekeeper and a special "savings account"E) All of the above
F) C) and D)

Question 5

Examine the list of services in the answer choices below and determine which one would most likely be considered a noncovered service at a primary care medical office.

Accepted Answer

A)   employment-related injuries
B)   emergency medical care
C)   annual physical examinations
D)   surgical proceduresE) All of the above
F) C) and D)

Question 6

Name a benefit a provider usually gets from participation with a health plan.

Accepted Answer

A)   no contractual duties
B)   more contractual duties
C)   a decreased number of patients
D)   an increased number of patientsE) A) and B)
F) B) and C)

Question 7

In general, how do the cost of policies written for groups compare to those written for individuals?

Accepted Answer

A)   Policies written for individuals are cheaper.
B)   Policies written for groups are cheaper.
C)   Policies written for individuals and groups cost the same.
D)   Policies written for groups are more expensive.E) All of the above
F) A) and B)

Question 8

Verifying insurance is part of which revenue cycle step?

Accepted Answer

A)   Step 3, check in patients.
B)   Step 2, establish financial responsibility for the visit.
C)   Step 10, follow up patient payments.
D)   Step 4, review coding compliance.E) A) and B)
F) A) and C)

Question 9

According to the textbook, pick the rising occupation in the health care industry that requires the employee to have the highest level of proficiency in dealing with the public professionally and pleasantly.

Accepted Answer

A)   medical assistant
B)   lab technician
C)   health information technician
D)   radiology technicianE) B) and D)
F) A) and B)

Question 10

Which of the following covers patients who are age 65 and over?

Accepted Answer

A)   CHAMPUS
B)   TRICARE
C)   Medicare
D)   MedicaidE) A) and B)
F) A) and C)

Question 11

Identify the type of service that is not considered to be a preventive medical service.

Accepted Answer

A)   prenatal care
B)   outpatient surgery
C)   pediatric and adolescent immunizations
D)   routine screening proceduresE) B) and C)
F) A) and D)

Question 12

A patient ledger records

Accepted Answer

A)   the patient's financial transactions.
B)   the day's appointments and payments.
C)   the patient's illnesses.
D)   the patient's relatives.E) All of the above
F) B) and D)

Question 13

Which of the following is an example of a private-sector payer?

Accepted Answer

A)   Medicaid
B)   workers' compensation insurance
C)   insurance company
D)   MedicareE) A) and B)
F) A) and D)

Question 14

Compare the choices below to determine which type of provider service would most likely NOT be covered by a health plan.

Accepted Answer

A)   a surgery performed on an outpatient basis
B)   an illness that started after the insurance coverage began
C)   a medical procedure that is not included in a plan's benefits
D)   all elective procedures performed in the hospitalE) A) and D)
F) B) and D)

Question 15

Which of the following characteristics should medical insurance specialists use when working with patients' records and handling finances?

Accepted Answer

A)   knowledge of medical terms
B)   communication skills
C)   honesty and integrity
D)   able to work as a team memberE) All of the above
F) A) and D)

Question 16

What step is used when patient payments are later than permitted under the financial policy?

Accepted Answer

A)   Step 2, establish financial responsibility for the visit.
B)   Step 4, review coding compliance.
C)   Step 10, follow up patient payments and collections.
D)   Step 3, check in patients.E) A) and B)
F) B) and C)

Question 17

When a POS option is elected under a health maintenance organization, the patient may

Accepted Answer

A)   choose providers who are not in the HMO's network.
B)   choose any provider without additional expense.
C)   choose providers only from the HMO's network.
D)   choose providers only from the IPA's network.E) None of the above
F) B) and C)

Question 18

Out-of-pocket expenses must be paid by

Accepted Answer

A)   the insurance company.
B)   the insured.
C)   the health plan.
D)   the provider.E) B) and C)
F) A) and D)

Question 19

Identify the advantages offered to patients in managed care plans, as compared to indemnity insurance.

Accepted Answer

A)   higher deductibles
B)   higher premiums
C)   lower premiums and charges
D)   lower premiums, charges, and deductiblesE) A) and C)
F) A) and B)

Question 20

In a preferred provider organization (PPO)  plan, referrals to specialists are

Accepted Answer

A)   not required.
B)   less expensive.
C)   more expensive.
D)   required.E) B) and C)
F) A) and D)

Exam 1: Introduction to the Medical Billing Cycle

Identify the type of service that is not considered to be a preventive medical service.

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Calculate the amount of money the insurance company would owe on a covered service costing $850 if there is a $500 deductible (which has not yet been met) and no coinsurance.

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Name a benefit a provider usually gets from participation with a health plan.

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Examine the list of services in the answer choices below and determine which one would most likely be considered a noncovered service at a primary care medical office.

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Compare the choices below to determine which type of provider service would most likely NOT be covered by a health plan.

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Name the two components of a consumer-driven health plan (CDHP) .

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When a POS option is elected under a health maintenance organization, the patient may

Correct AnswerverifiedShow Answer

Verifying insurance is part of which revenue cycle step?

Correct AnswerverifiedShow Answer

In general, how do the cost of policies written for groups compare to those written for individuals?

Correct AnswerverifiedShow Answer

Which of the following covers patients who are age 65 and over?

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In a preferred provider organization (PPO) plan, referrals to specialists are

Correct AnswerverifiedShow Answer

Which of the following is an example of a private-sector payer?

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A patient ledger records

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According to the textbook, pick the rising occupation in the health care industry that requires the employee to have the highest level of proficiency in dealing with the public professionally and pleasantly.

Correct AnswerverifiedShow Answer

Identify the type of HMO cost-containment method that requires patients to obtain approval for services before they receive the treatment.

Correct AnswerverifiedShow Answer

Out-of-pocket expenses must be paid by

Correct AnswerverifiedShow Answer

What step is used when patient payments are later than permitted under the financial policy?

Correct AnswerverifiedShow Answer

Health care claims report data to payers about __________ and __________.

Correct AnswerverifiedShow Answer

Identify the advantages offered to patients in managed care plans, as compared to indemnity insurance.

Correct AnswerverifiedShow Answer

Which of the following characteristics should medical insurance specialists use when working with patients' records and handling finances?

Correct AnswerverifiedShow Answer

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Health care claims report data to payers about and .

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