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 coverage

B compensation

C renewal

D grant

Question #2

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

A TRUE

B FALSE

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 TRUE

B FALSE

Question #5

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

A FALSE

B TRUE

Question #6

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

A All of these.

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

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

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

Question #7

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

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

B All of these.

C Insurance companies are banned from restricting emergency room 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 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 have the right to appeal an insurance company decision with an independent third party.

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

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 receive emergency services without penalty.

C know your treatment options.

D sue the managed care organization.

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 liability.

B no fault.

C stoploss coverage.

D hold harmless.

Question #11

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 #12

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

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

B based on recognized standards of the specialty involved.

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

D experimental, investigative, or unproven.

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 coordination of benefits.

B coordination of services.

C case management.

D benefit determination.

Question #14

In cases of fraudulent billing:

A the medical office specialist can be held liable.

B the physician can never 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 provider and patient & the employer and carrier

B the provider and patient & the provider and carrier

C the patient and employer & the employer and carrier

D the patient and employer & the provider and carrier

Question #16

The following is true of Obamacare:

A All of these.

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

C employers are mandated to furnish healthcare or be fined.

D preventative care is more accessible.

Question #17

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

A the passing of Medicaid.

B the passing of Medicare.

C the passing of Obamacare.

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

Question #18

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

A return to fee-for-service payments.

B focus on efficiency, cost reduction, and profit.

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

B It is part of a Medicare Advantage plan.

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

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 per case

B discounted fee-for-service

C per diem

D capitation

Question #21

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 #22

An increase in patient volume is often caused by:

A percentage of premium and capitation contracts.

B capitation contracts.

C per diem and per case contracts.

D discounted fee-for-service contracts.

Question #23

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

A per case

B discounted fee-for-service

C capitation

D annual fee

Question #24

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

A increasing administrative duties.

B bringing more patients to the practice.

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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