Chapter 13 Cert Quiz

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Section 1

Question Answer
When a patient gives written authorization for reimbursement to the physician for billed charges, this is called assignment of benefits
Coordination of benefits meansone insurance plan will work with other insurance plans to determine how much each plan pays
The person who is covered by a benefits plan is theinsured
A person's spouse or child who is covered under the benefits plan is called thedependent
The amount that will be paid by the insurance plan for each procedure or service is based on thefee schedule
A government sponsored program that provides health benefits to low income or indigent persons is Medicaid
Expenses resulting from work related illness or injury are usually covered byWorkers Compensation
The statement issued to the provider and the patient that lists the details of a payment that has been made by the insurance plan is theexplanation of benefits
If a patient is diagnosed with a disease before the effective date of the insurance plan it is a(n)preexisting condition
The amount of eligible charges each patient must pay each calendar year before the plan begins to pay benefits is calleddeductible
Medicare is a federal health insurance program forindividuals 65 years of age or older and are eligible for social security benefits
Medicare Part A provides coverage for hospitalization
The process of determining whether a service or procedure is covered by the insurance provider is calledprecertification
The medical bills of spouses and children of veterans with total, permanent, service connected disabilities are covered underCHAMPVA
The process of making a payment to a provider based on a fixed amount per enrollee assigned to that provider regardless of servces provided iscapitation
A group of physicians who receive cases for appropriateness of hospitalizations and discharges is calledquality improvement organization
A health maintenance organization is best described as a group of physicians who have a contract to provide services to participating patients for a predetermined fee
A calculation of charges for each procedure indicating the charge of the majority of physicians in a geographic area is referred to asresource based value system

Section 2

Question Answer
Medicare part B does NOT coverhospitalization
Health benefit policies are purchased by an individual by paying the premium
A PCP isa general practitioner who takes care of the routine medical needs of patients including wellness services
A condition or circumstance for which the health insurance policy will not provide benefits is a(n)exclusion
Insurance coverage that provides a specific monthly or weekly income when an individual becomes unable to work because of an illness or injury is disability income insurance
The amount of money owed by the insured to the provider at the time of service is calledco-payment
When a dependent child is covered by the benefit plans of both parents, determination of the primary carrier is based onbirthday rule
In order to be eligible for medicare part C, the participant must be enrolled inMedicare part A and part B
The medicare part specifically designed to provide pharmaceutical coverage is Part D
A hospital payment system that categorizes patients by diagnosis and treatment is referred to as DRG
UCR provider payments are based onWhat the majority of physicians in a specific geographic area charge for procedures
When a medicare patient is told that he or she may be responsible for payment of services not covered by medicare, the physicians office should inform the patient and hae the patient sign a form called a(n) ABN
Edward Brandon was permanently injured while working on the railroad after 20 years of service; he is most likely eligible for which type of comprehensive health insuranceMedicare
Mary works for a small business which provides health insurance for her, but her family coverage is too expensive given her modest income; Mary's insurance is calledcommercial
Christopher lives at home and has a low wage part-time job which is considered a portion of the family income and puts the family above the 133% of poverty which does not qualify for Medicaid. His job does not provide health insurance. He may be eligible to purchase insurance throughACA plan
Chelsey is not eligible for coverage under her fathers or mothers health insurance. Due to the family's modest income, she most likely is eligible forCHIP
To compare insurance rates and to see what plans are available through the ACA, Christopher goes to the health insurance exchange known asthe marketplace