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Flashcards in Midterm Part 1 Deck (10)
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1
Q

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

A

Independent practice Association

2
Q

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

A

Once a year

3
Q

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

A

UB-04

4
Q

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

A

Returned to nonprofit corporation

5
Q

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

A

$150

6
Q

TRUE/FALSE: The patient and the guarantor are always the same person.

A

False

7
Q

In regards to healthcare insurance, the percentage that the guarantor pays is called the _________.

A. Copayment
B. Coinsurance
C. Contractual disallowance
D. Deductible

A

Coinsurance

8
Q

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

A

Provider accepts as payment in full whatever the payer reimburses

9
Q

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

A

High-risk pool

10
Q

Do you have to apply for Medicare on the exact day that you turn 65?

A. No
B. Yes

A

No