Question 1

Written approval from a managed care plan or insurer given before a patient is admitted to a hospital or receives a particular treatment is known as ________.

Accepted Answer

preauthorization

Question 2

Why is knowledge of the history of healthcare in America important for a medical office assistant?

Accepted Answer

This knowledge will assist the...

Question 3

Explain how members see a specialist in a health maintenance organization (HMO) plan.

Accepted Answer

Members can only see...

Question 4

Match the following
-The type of managed care plan that combines the features of health maintenance organization (HMO)  and preferred provider organization (PPO)  plans

Accepted Answer

A)   individual practice association (IP
A)   health maintenance organization (HMO) 
B)   staff model health maintenance organization (HMO) 
C)   major medical insurance
D)   outpatient insurance
E)   open access health maintenanceF)  exclusive provider organization (EPO) G)  point-of-service (POS)  planH)  network model health maintenance organization (HMO) I)  long-term care insuranceJ)  preferred provider organization (PPO)

Question 5

The federal law that makes it possible for most people to continue their group health coverage for a period of time after leaving a job is called ________.

Accepted Answer

The answer of The federal law that makes it possible...

Question 6

Physician-hospital organizations (PHOs)  may include:

Accepted Answer

A)   nursing homes.
B)   laboratories.
C)   surgery centers.
D)   all of the above.

Question 7

The goals of managed care include all of the following EXCEPT:

Accepted Answer

A)   medical care that is medically necessary and appropriate based on the patient's condition and diagnosis.
B)   medical care rendered by the most appropriate provider.
C)   medical care rendered in the most appropriate setting.
D)   medical care rendered in the most profitable setting.

Question 8

In a managed care organization (MCO) contract, the provider will bill the patient the difference between the standard fee and the contractual or discount amount.

Accepted Answer

A) True 
 B)False

Question 9

Match the following
-A type of HMO in which the MCO contracts with individual physicians and facilities to build the provider network

Accepted Answer

A)   individual practice association (IP
A)   health maintenance organization (HMO) 
B)   staff model health maintenance organization (HMO) 
C)   major medical insurance
D)   outpatient insurance
E)   open access health maintenanceF)  exclusive provider organization (EPO) G)  point-of-service (POS)  planH)  network model health maintenance organization (HMO) I)  long-term care insuranceJ)  preferred provider organization (PPO)  A

Question 10

All the following are true regarding HMOs EXCEPT:

Accepted Answer

A)   regulated by federal and state law.
B)   encourage preventative health services.
C)   the least restrictive type of care plan.
D)   require a referral for specialist services.

Question 11

All the following are true regarding the Affordable Care Act EXCEPT:

Accepted Answer

A)   It is also known as Obamacare.
B)   It cannot deny coverage due to a pre-existing condition.
C)   It offers five different types of government plans.
D)   It requires people to prove citizenship before receiving services.

Question 12

The restrictions in a health maintenance organization (HMO) reduce members' premium costs.

Accepted Answer

A) True 
 B)False

Question 13

The type of health maintenance organization (HMO)  plan that involves contracting with individual physicians to create a healthcare delivery system is a(n) :

Accepted Answer

A)   group model.
B)   individual practice association (IP
A)   model.
C)   network model.
D)   staff model.

Question 14

The type of health maintenance organization (HMO)  that contracts with more than one community-based multispecialty group to provide wider geographical coverage is a(n) :

Accepted Answer

A)   group model.
B)   individual practice association (IP
A)   model.
C)   network model.
D)   staff model.

Question 15

When compared to individual insurance, group insurance provides:

Accepted Answer

A)   fewer benefits and lower costs.
B)   fewer benefits and higher costs.
C)   better benefits and higher costs.
D)   better benefits and lower costs. D

Question 16

List three reasons why managed care organizations (MCOs) are criticized.

Accepted Answer

MCOs are criticized for making it diffic...

Question 17

Match the following
-The type of insurance that offers protection for large medical expenses beyond the coverage of routine healthcare

Accepted Answer

A)   individual practice association (IP
A)   health maintenance organization (HMO) 
B)   staff model health maintenance organization (HMO) 
C)   major medical insurance
D)   outpatient insurance
E)   open access health maintenanceF)  exclusive provider organization (EPO) G)  point-of-service (POS)  planH)  network model health maintenance organization (HMO) I)  long-term care insuranceJ)  preferred provider organization (PPO)

Question 18

To determine the amount due from a patient, it is necessary to know the:

Accepted Answer

A)   billed amount.
B)   allowed amount.
C)   adjusted amount.
D)   diagnostic code.

Question 19

Explain the duties of a primary care physician (PCP) in a health maintenance organization (HMO).

Accepted Answer

A PCP (gatekeeper) coordinates...

Question 20

An insurance identification card usually includes all of the following information EXCEPT:

Accepted Answer

A)   name of the insurance policy.
B)   name of the subscriber.
C)   detailed benefit information.
D)   insurance policy number.

Exam 2: Understanding Managed Care: Insurance Plans

Written approval from a managed care plan or insurer given before a patient is admitted to a hospital or receives a particular treatment is known as ________.

Correct Answerverifiedpreauthorization

Why is knowledge of the history of healthcare in America important for a medical office assistant?

Correct AnswerverifiedThis knowledge will assist the...View AnswerShow Answer

Explain how members see a specialist in a health maintenance organization (HMO) plan.

Correct AnswerverifiedMembers can only see...View AnswerShow Answer

Match the following -The type of managed care plan that combines the features of health maintenance organization (HMO) and preferred provider organization (PPO) plans

Correct AnswerverifiedShow Answer

The federal law that makes it possible for most people to continue their group health coverage for a period of time after leaving a job is called ________.

Correct AnswerverifiedShow Answer

Physician-hospital organizations (PHOs) may include:

Correct AnswerverifiedShow Answer

The goals of managed care include all of the following EXCEPT:

Correct AnswerverifiedShow Answer

In a managed care organization (MCO) contract, the provider will bill the patient the difference between the standard fee and the contractual or discount amount.

Correct AnswerverifiedShow Answer

Match the following -A type of HMO in which the MCO contracts with individual physicians and facilities to build the provider network

Correct AnswerverifiedA

All the following are true regarding HMOs EXCEPT:

Correct AnswerverifiedShow Answer

All the following are true regarding the Affordable Care Act EXCEPT:

Correct AnswerverifiedShow Answer

The restrictions in a health maintenance organization (HMO) reduce members' premium costs.

Correct AnswerverifiedShow Answer

The type of health maintenance organization (HMO) plan that involves contracting with individual physicians to create a healthcare delivery system is a(n) :

Correct AnswerverifiedShow Answer

The type of health maintenance organization (HMO) that contracts with more than one community-based multispecialty group to provide wider geographical coverage is a(n) :

Correct AnswerverifiedShow Answer

When compared to individual insurance, group insurance provides:

Correct AnswerverifiedD

List three reasons why managed care organizations (MCOs) are criticized.

Correct AnswerverifiedMCOs are criticized for making it diffic...View AnswerShow Answer

Match the following -The type of insurance that offers protection for large medical expenses beyond the coverage of routine healthcare

Correct AnswerverifiedShow Answer

To determine the amount due from a patient, it is necessary to know the:

Correct AnswerverifiedShow Answer

Explain the duties of a primary care physician (PCP) in a health maintenance organization (HMO).

Correct AnswerverifiedA PCP (gatekeeper) coordinates...View AnswerShow Answer

An insurance identification card usually includes all of the following information EXCEPT:

Correct AnswerverifiedShow Answer

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preauthorization

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This knowledge will assist the...
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Members can only see...
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A

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D

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MCOs are criticized for making it diffic...
View Answer

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A PCP (gatekeeper) coordinates...
View Answer

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