MA INSURANCE

The first insurance plans began during what war?
a. Civil
b. WW1
c. WWII
d. None of the above

What was the first type of insurance created?
a. Accident
b. basic medical
c. dental
d. vision

The first health insurance was created to cover?
a. basic medical expenses
b. the frequent railroad and steamboat disasters of the era
c. lost income because of disability
d. as many people as possible under group coverage

The first group policy giving comprehensive benefits emerged in
a. 1929
b. 1943
c. 1847
d. 1965

The prepaid concept became the foundation for ____ insurance.
a.Aetna
b. Prudential
c. State Farm
d. Blue Cross

The goal of Blue Cross/Blue Shield was to
a. cover only the frequent disasters of the era
b. cover lost income because of disability
c. make health insurance accesible to as many people as possible
d. negotiate for fringe benefits of employment

The first modern group health insurance became an employment benefit because...
a. a group of school teacher s in Dallas, Texas joined forces and requested it
b. a WWII and a 'hold-the-line' wage freeze
c. there was a financial need to keep health care costs down
d. there was no coverage for the elderly population who retired

The first national health insurance for Americans age 65 and older is
a. Medicaid
b. Medicare
c. Disability
d. liabity

The underlying principle of all types of insurance is
a. the concept of liability
b. the law of probabliity
c. let the buyer beware
d. Boyle's Law

The term CO-INSURANCE means...
a. the patient has two or more insurance policies
b. that the insured pays or shares part of the medical bill with the insurance company, usually according to a fixed percentage.
c.the patient an his or her spouse have a joint policy
d. the insured and the employer share the cost of premuim as in the case of a group policy

The amount required to be paid by the insured under a health insurance contract benefits become payable is referred to as
a. an assignment
b. co-insurance
c.a deductible
d. an exclusion

Many patients carry supplementary medical coverage beyond the basic medical and surgical policies. These are commonly referred to as
a. major medical insurance
b.comprehensive coverage
c. disaster coverage
d.master medical insurance

Which of the following is true of Part A Medicare?
a. a monthly premium is required
b. there is a deductible
c. only 80% of charges will be reimbursed
d. there have been few changes in the plan since its inception in 1960

What is true regarding Part B Medicare?
a.Participation in the plan is voluntary
b.A Monthly premium must be paid
c.The patient must pay a deductible.
d. All of the above

When prepary any Medicare claim form, cetain information must be obtained from the patient's ID card. What is not included?
a. the beneficiary's name
b. the claim number
c. the type of coverage
d. the beneficiary's address

Which of the following services is not covered under Part B Medicare?
1. Routine physical Exams
2. prescriptions for eyeglasses and hearing aids
3. Radiation therapy
4. Rental of wheelchairs

The most common reason for Medicare claim forms being rejected without any payment is because of
a. incomplete information and errors
b. this charges were disallowed
c. the doctors failed to accept assignment
d. a supplier other than an MD provided services.

The federal government participates with each of the individual states in a medical assistance plan for the indigent known as
a. Medicare II
b. Medicaid
c. Welfare
d. CHAMPUS

Medicaid is
a. a private health insurance program
b.low-cost government health insurance for the needy
c. a government health insurance plan for military personnel
d. a program of medical care for the needy provided by the title XIX of the Social Secruity Amendments of 1965

Blue Cross and Blue Shield insurance plans are nonprofit organizations and as such

a. Pay no benefits
b. operate at a continual loss
c. are considered as charitable instututions
d. None of the above

Under a law passed in 1956, CHAMPUS provides medical and hospital care for
a. all dependents of members of the armed services on active duty.
b. all retired military personnel and their dependents
c. members of the Coast Guard

The medical assistant should always check the CHAMPUS beneficiary notification card because loss of eligibility is automatic at

An insurance contract written for a company for its employees is called
a. free coverage
b. group coverage
c. individual coverage
d. benefit coverage

A patient who is 68 years old is most likely covered by what type of insurance?

Medicare pays

To establish eligibility for medicaid you must cheick their
a. current ID
b. policy number
c. social security number

Persons who are unable to pay for medical care or who have dependent children, may apply for

What kind of insurance provides medical care for job-related accidents and illness?

The type of insurance that provides income when the insured is unable to work due to ilness or injury is
a. Workman's Compensation
b. Disability
c. Medicare
d. HIC

The physician or supplier giving medical care or serves is called
a. subscriber
b. provider
c. carrier
d. dependent

What is the person called who carries the medical insurance?
a. subscriber
b. provider
c.member physician
d.dependent physician

The word indicating the date medical insurance coverage begins is

Insurance that provides weekly or monthly cash benefits to employed policy holders who become unable to work because of accidents or illness is called
a. special risk insurance
b. loss of income protection
c. personal accident
d. surgical insurance

CATASTROPHIC coverage is referred to as

Hospital insurance is included under Medicare
a. in Part A
b. In Part B
c. Only for those who are over 70 years of age
d. only for those who pay an additional premium

Blue Shield makes direct payments to
a. physician members
b. all physician
c. all policy holders
d. the hospital

A bed patient in a hospital who is entitled to Medicare benefits is covered for up to

Within 48 hours after a physician has seen a Workman's Compensation patient for the first time, a report is type

A bill is never sent to the patient in which type of case?
a. Medicare
b. Workman's Compensation
c. Blue Cross
d. HIC

The amount charged for a medical insurance policy is called
a. beneficiary
b. Claim
c. fee schedule
d. premium

Coordination of benefits is also known as
a. pre-existing conditions
b. exclusions
c. coinsurance
d. non-duplication of benefits

Blue Cross offers which method of reimbursement?
a. fee for service
b. capitation
c. closed panel
d. salary

In most cases, the insurer pays an annual cost or ___ for health care insurance.
a. coinsurance
b. deductible
c. premium
d. co-payment

A fixed dollar amount the subscriber must pay or "meet" each year before the insurer begins to cover expenses is the
a. co-payment
b. deductible
c. premium
d. coinsurance

Some medical practices may require the subscriber to pay a small fee at the time of service, called a
a. co-payment
b.exclusion
c. deductible
d. coinsurance

The Physicians' Current Procedural Terminology (CPT) manual provides
a. comprehensive information on prescription medications
b. procedure and diagnosis codes
c.descriptions of common medical procedures
d. a fee schedule for medical services and procedures

In a typical medical practice, insurance claims are filed
a. 7-10 business days from the date of service
b. 9 months after the service is rendered
c.one year from the date of use
d. at any time

The most likely outcome of a submitted insurance claim with a diagnosis code of a sore throat and a treatment code indicating a cast for a broken leg would be
a. coverage at 100 percent
b. the fee for service would be applied toward the patient's deductible
c.denied as a billing error because the treatment was not medically necessary based on diagnosis
d. the patient may have to pay a coinsurance after the deductible is met.

When an insurance claims department compares the fee the doctor charges with the benefits provided by the patient's health insurance, it is called the
a. payment of benefit
b. review of medical necessity
c. review for allowable benefits
d. explanation of benefits

Which of the following is what the patient owes after insurance company has paid?
a. premium
b. exclusion
c. subscriber liability
d. comorbidity

The most appropriate response from a medical assistant when a patient alls the medical practice questioning why an insurance claim was rejected is
a. "I will ask your physician"
b."The service must not be covered"
c. "Check your explanation of benefits form"
d."Is your deductible met?"

The average fee a physician charges for a service or procedure is the ___ fee.
a. customary
b. reasonable
c. prevailing
d. usual