Weekly Quiz 2 Chapter 3

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Question #1

A managed care contract specifies covered services, reimbursement amounts, and the method of ________ for the contracted physician.

A compensation

B coverage

C renewal

D grant

Question #2

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

A FALSE

B TRUE

Question #3

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 #4

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 #5

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

A TRUE

B FALSE

Question #6

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

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

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

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

D All of these.

Question #7

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 restricting emergency room care.

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

D Insurance companies are banned from limiting choice of doctors.

Question #8

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

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

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

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

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

Question #9

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

A accurate and easily understood information.

B sue the managed care organization.

C know your treatment options.

D receive emergency services without penalty.

Question #10

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 hold harmless.

B stoploss coverage.

C no fault.

D liability.

Question #11

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

A contracted entity.

B covered person.

C payer.

D provider.

Question #12

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

A experimental, investigative, or unproven.

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

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

D based on recognized standards of the specialty involved.

Question #13

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 services.

D coordination of benefits.

Question #14

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 #15

A medical office specialist works as a liaison between:

A the patient and employer & the employer and carrier

B the provider and patient & the employer and carrier

C the provider and patient & the provider and carrier

D the patient and employer & the provider and carrier

Question #16

The following is true of Obamacare:

A preventative care is more accessible.

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

C employers are mandated to furnish healthcare or be fined.

D All of these.

Question #17

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

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

B the passing of Medicare.

C the passing of Medicaid.

D the passing of Obamacare.

Question #18

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

A focus on efficiency, cost reduction, and profit.

B return to fee-for-service payments.

C emphasis on the doctor—patient relationship.

D focus on administrative requirements and paperwork.

Question #19

All the following are true regarding an ACO EXCEPT:

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

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

C It is part of a Medicare Advantage plan.

D It participates in a Medicare Shared Savings Program.

Question #20

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

A capitation

B per case

C discounted fee-for-service

D per diem

Question #21

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

A discounted fee-for-service

B fee-for-service

C capitation

D percentage of premiums

Question #22

An increase in patient volume is often caused by:

A discounted fee-for-service contracts.

B percentage of premium and capitation contracts.

C per diem and per case contracts.

D capitation contracts.

Question #23

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

A capitation

B annual fee

C discounted fee-for-service

D per case

Question #24

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

A bringing more patients to the practice.

B increasing administrative duties.

C keeping costs down.

D adding opportunities for staff development.

Question #25

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

A physicians.

B pharmacies.

C All of these.

D facilities.

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Weekly Quiz 2 Chapter 3

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