Chapter 3 Quiz

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Question #1

A medical office specialist should always document, sign, and date all conversations regarding any patient’s account.

A FALSE

B TRUE

Question #2

The Patient’s Bill of Rights under the Affordable Care Act put an end to insurance companies limiting choice of doctors.

A TRUE

B FALSE

Question #3

A medical office specialist cannot be held liable for fraudulent billing practices if told to do so by a physician.

A FALSE

B TRUE

Question #4

A managed care contract that involves payment through capitation provides incentives for physicians to emphasize preventive care.

A FALSE

B TRUE

Question #5

Which of the following are new laws in the Patient’s Bill of Rights under the Affordable Care Act?

A no one can be denied coverage because of a pre-existing medical condition.

B insurance companies can no longer put a lifetime limit of the amount of coverage.

C All of these.

D a patient cannot be dropped from coverage due to an unintentional mistake on their application.

Question #6

Which of the following is true of the new Patient’s Bill of Rights under the Affordable Health Care Act?

A All of these.

B Insurance companies are banned from limiting choice of doctors.

C Insurance companies are banned from restricting emergency room care.

D Insurance companies are prohibited from charging patients for preventative care.

Question #7

All of the following regarding the Patient’s Bill of Rights are true EXCEPT:

A Patients can receive preventative care without paying deductibles, coinsurance, or copayments.

B Patients joining a new plan can choose their own doctor in the insurer network.

C Patients may receive financial reimbursement for out of network penalties.

D Patients have the right to appeal an insurance company decision with an independent third party.

Question #8

Principles adopted in the Patient’s Bill of Rights include all of the following EXCEPT the right to:

A sue the managed care organization.

B accurate and easily understood information.

C know your treatment options.

D receive emergency services without penalty.

Question #9

The contract provision that states a physician cannot seek payment from a patient under a managed care contract in relation to any benefit penalties that were applied based on a utilization review decision is:

A liability.

B stoploss coverage.

C hold harmless.

D no fault.

Question #10

An individual who is an insured, enrolled subscriber or dependent under the terms of a health benefit plan is a(n):

A payer.

B provider.

C covered person.

D contracted entity.

Question #11

Medically necessary services include all of the following EXCEPT services that are:

A based on recognized standards of the specialty involved.

B accepted by the healthcare profession as appropriate and effective for the condition being treated.

C experimental, investigative, or unproven.

D not solely for the convenience of a covered person or a healthcare provider.

Question #12

When a person has health insurance coverage through two or more plans, the determination of which plan will provide benefits as primary or secondary payer is known as:

A benefit determination.

B case management.

C coordination of benefits.

D coordination of services.

Question #13

In cases of fraudulent billing:

A the physician can never be held liable.

B the medical office specialist can be held liable.

C only the physician can be held liable.

D the medical office specialist can never be held liable.

Question #14

A medical office specialist works as a liaison between: (Select all that apply),,

A the provider and carrier.

B the employer and carrier.

C the patient and employer.

D the provider and patient.

Question #15

The following is true of Obamacare:

A requires all insurance plans to cover contraceptives at no cost.

B preventative care is more accessible.

C employers are mandated to furnish healthcare or be fined.

D All of these.

Question #16

The Affordable Care Act represents the most significant overhaul of the U.S. healthcare system since:

A the passing of Obamacare.

B the passing of Medicare.

C the passing of Medicaid.

D Both the passing of Medicaid and the passing of Medicare.

Question #17

Business values incorporated into medical practices as a result of managed care include a(n):

A focus on efficiency, cost reduction, and profit.

B emphasis on the doctor—patient relationship.

C focus on administrative requirements and paperwork.

D return to fee-for-service payments.

Question #18

All the following are true regarding an ACO EXCEPT:

A It needs a patient’s authorization to release medical information.

B It is part of a Medicare Advantage plan.

C It shares the patient’s information with its network of providers.

D It participates in a Medicare Shared Savings Program.

Question #19

Which type of payment method creates an incentive to provide more preventive care?

A per case

B capitation

C discounted fee-for-service

D per diem

Question #20

A contract with which of the following payment terms can result in an increased financial risk to the provider?

A percentage of premiums

B discounted fee-for-service

C fee-for-service

D capitation

Question #21

An increase in patient volume is often caused by:

A capitation contracts.

B discounted fee-for-service contracts.

C per diem and per case contracts.

D percentage of premium and capitation contracts.

Question #22

Which of the following is NOT a common type of payment arrangement in a managed care contract?

A annual fee

B per case

C capitation

D discounted fee-for-service

Question #23

The benefits of a managed care contract to the provider include:

A keeping costs down.

B adding opportunities for staff development.

C increasing administrative duties.

D bringing more patients to the practice.

Question #24

Managed care organizations (MCOs) develop a network by contracting with:

A facilities.

B physicians.

C pharmacies.

D All of these.

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