Insurance Basics Quiz

Insurance Basics Multiple Choice Identify the choice that best completes the statement or answers the question ____ 1 The business of protecting, through legal means, a person or property against loss or harm is referred to as a prevention b insurance c a contract d preclusion ____ 2 Health insurance narrows down undesirable events to a illnesses and injuries b automobile accidents c preventive illnesses d preexisting conditions ____ 3 Securitas is the Latin term for a services b specialist c security d success ____ 4 The “birth” of health insurance in this country occurred in a 1889 b 1900 c 1915 d 1929 ____ 5 The federal healthcare program for the elderly and certain qualifying others is a Medicare b Medicaid c Blue Cross d Health maintenance ____ 6 The combined federal and state healthcare program for indigent and low income individuals is a Medicare b Medicaid c Blue Cross d health maintenance ____ 7 A relatively new concept of healthcare structure that emerged in the late twentieth century is a managed care b Blue Shield c major medical d family care ____ 8 Congress passed the Health Maintenance Organization Act in a 1950 b 1965 c 1973 d 1987 ____ 9 Factors listed in the text that drive healthcare issues include all of the following except a regulating managed care plans b expanding access for uninsured Americans c reducing healthcare costs d stabilizing emergency services ____ 10 Many employed individuals obtain healthcare coverage through a/an a group plan b individual policy c government-sponsored program d guaranteed insurance pool ____ 11 The following groups that are typically without health insurance include all except those who are a self-employed b employed part time c employed in low wage jobs d employed in government jobs ____ 12 The acronym for the congressional act that circumvents problems such as preexisting conditions as well as other healthcare related issues is a AMA b COBRA c HIPAA d EMTLA ____ 13 The situation whereby patients pay a certain portion of healthcare costs (eg, deductible and copayment) is called a cost sharing b equalizing c standardizing d community rating ____ 14 Actuaries use statistics to predict anticipated healthcare costs, which establish a riders b premiums c high risk pools d risk assessment clusters ____ 15 Fee-for-service healthcare plans are also referred to as a managed care b preventive plans c indemnity insurance d health maintenance organizations ____ 16 Understanding what you read is called a application b comprehension c communication d interpretation ____ 17 Sending and receiving information through mutually understood methods is a application b comprehension c communication d interpretation ____ 18 When you stick with a task until it is completed, you are a diligent b reticent c obstinate d obedient ____ 19 When you have honest, ethical, and moral principles, you are said to have a objectivity b practicality c flexibility d integrity ____ 20 If you are not influenced by personal feelings, biases, or prejudice, you have a objectivity b practicality c flexibility d integrity ____ 21 To write down important lecture facts in one’s own words is called a outlining b plagiarizing c documenting d paraphrasing ____ 22 Organizing daily responsibilities according to their importance is called a colonizing b multitasking c prioritizing d categorizing ____ 23 College entry-level skills necessary for success as a health insurance professional include all of the following except a coding b basic business math c English and grammar skills d keyboarding and computer skills ____ 24 Success in getting the most out of one’s education and optimizing career potential facilitates a lifelong learning b autonomy c career identity d individuality ____ 25 In order to develop effective study skills, it is suggested that students generate a _____ schedule a career objective b time management c professional education d goal oriented ____ 26 The nationally recognized job title for individuals who specialize in medical insurance claims submission is a insurance billing specialist b health insurance professional c health information technician d There is no nationally recognized title ____ 27 One method of enhancing one’s career as a health insurance professional is to acquire a certification b nationalization c legalization d specialization ____ 28 Those who work in healthcare say the most important reward is a earning a good salary b getting promoted c becoming certified d helping people ____ 29 Career opportunities for a health insurance professional include a physician’s offices b healthcare organizations c nursing homes d All of the above are correct ____ 30 When a society tends to be hasty in bringing lawsuits, it is said to be a illegal b litigious c diligent d formidable ____ 31 The Latin term for “let the master answer” is a litigious b ancillary c negligent d respondeat superior ____ 32 Members of a medical team who are not physicians are called _____ members a Cohort b third party c ancillary d emancipated ____ 33 Elements of a legal contract include all of the following except a an attorney b Consideration c competent parties d offer and acceptance ____ 34 A proposition to create a contract is the a offer b acceptance c consideration d binding element ____ 35 The “thing of value” that each party gives to the other is the a offer b acceptance c consideration d binding element ____ 36 A contract can be terminated when a a full year has passed b both parties agree to terminate it c either party defaults on the provisions d Both b and c are correct ____ 37 The type of contract that exists between a healthcare provider and a patient is a/an a implied contract b verbal contract c written contract d All of the above are correct ____ 38 When certain precise steps are not followed when a physician terminates the patient/doctor contract it is called a cessation b termination c abandonment d altercation ____ 39 A health insurance company is referred to as the a first party b second party c third party d fourth party ____ 40 The federal act that states that Medicare is the secondary payer in the case of automobile or liability coverage is the a Federal Privacy Act of 1974 b Federal Omnibus Budget Reconciliation Act of 1980 c Tax Equity and Fiscal Responsibility Act of 1982 d Consolidated Omnibus Budget Reconciliation Act of 1986 ____ 41 The act that made Medicare benefits secondary to employer group health plans for employees (or spouses) over 65 is the a Federal Privacy Act of 1974 b Federal Omnibus Budget Reconciliation Act of 1980 c Tax Equity and Fiscal Responsibility Act of 1982 d Consolidated Omnibus Budget Reconciliation Act of 1986 ____ 42 The act that addresses the prevention of healthcare fraud and abuse of patients eligible for Medicare and Medicaid benefits is the a Fraud and Abuse Act b Federal Privacy Act of 1974 c Federal Omnibus Budget Reconciliation Act of 1980 d Tax Equity and Fiscal Responsibility Act of 1982 ____ 43 Standards of human conduct (sometimes called morals) are a ethics b etiquette c socialization d protocol ____ 44 Following the rules and conventions governing correct or polite behavior in society is called a ethics b etiquette c socialization d protocol ____ 45 HIPAA was signed into law in a 1988 b 1996 c 2000 d 2005 ____ 46 In compliance with HIPAA, when patients visit their healthcare providers for treatment, they are given a a privacy statement b waiver of accountability c availability statement d Both a and b are correct ____ 47 When two patients recognize each other in a medical practice’s reception area, HIPAA refers to this as a/an a breach of confidentiality b infringement of etiquette c incidental disclosure d violation of compliance ____ 48 The Office of Inspector General (OIG) recommends all medical facilities have a a protection policy b soundproof exam room c third-party review panel d HIPAA compliance plan ____ 49 Medicare and Medicaid records must be kept a minimum of _____ years a two b three c five d Ten ____ 50 Before medical information can be divulged to a third party, the patient should sign a a written consent form b assignment of benefits form c release of medical information form d Either a or c is correct ____ 51 Exceptions to confidentiality include all of the following except a child abuse b emergency treatment c communicable diseases d injuries caused by firearms ____ 52 An authorization to release information should contain all of the following except the a patient’s name b primary diagnosis c patient’s signature d description of the information to be released ____ 53 When a health insurance professional intentionally and knowingly misrepresents facts to increase the payment of a claim, it is commonly known as a fraud b abuse c criminal intent d a breach of etiquette ____ 54 Improper methods of doing business that are contradictory to accepted business practices is a definition of a fraud b abuse c criminal intent d a breach of etiquette ____ 55 The primary objectives of HIPAA include all of the following except to a ensure health insurance portability b reduce healthcare fraud/abuse c enforce standards for health information d lower healthcare costs ____ 56 Upcoding and unbundling of charges are examples of a healthcare fraud b confidentiality breaches c HIPAA deregulations d exceptions to privacy ____ 57 A clinical, scientific, administrative, and legal document of facts containing statements relating to a patient is a definition of a/an a compliance plan b HIPAA standard c medical record d retention statute ____ 58 Failure to exercise a reasonable degree of care is a definition of a fraud b abuse c a crime d negligence ____ 59 A legal document that requires an individual to appear in court with a piece of evidence that can be examined by the court is called a/an a Respondeat superior b subpoena duces tecum c certificate of evidence d notarized sanction ____ 60 The traditional kind of health insurance wherein patients can choose any provider or hospital they wish and change physicians at will is a indemnity b fee-for-service c managed care d Both a and b are correct ____ 61 The periodic fee paid for health insurance is commonly called a a stipend b premium c penalty d disbursement ____ 62 The dollar amount that a patient must pay each year before his/her insurance benefits begin is called a a premium b copayment c deductible d imbursement ____ 63 Most health insurers ask that patients pay a portion of the charge called the a UCR b coinsurance c deductible d imbursement ____ 64 Insurance payments are typically based on a UCR rates b individual state rates c average national rates d international rates ____ 65 Insurance companies often cap what a patient must pay, which is referred to as the a cap rate b maximum pay c limited amount d out-of-pocket maximum ____ 66 The form that is most commonly used today for insurance claims is the a UB-04 b CMS-1500 c HCFA-1490 d HCPCS 1090 ____ 67 When both basic and major medical coverage is combined into one insurance plan, it is called a a comprehensive plan b combination coverage c a unilateral contract d a managed care plan ____ 68 Medical illnesses or injuries that a patient has prior to the purchase of a health insurance policy are called a riders b exemptions c policy precursors d preexisting conditions ____ 69 People who are covered under managed care plans are commonly referred to as a enrollees b policyholders c charter members d covered entities ____ 70 An insurance contract made with a business entity that covers its employees equally is called a a group contract b business contract c equilateral contract d managed care plan ____ 71 When an individual purchases a healthcare policy from a commercial insurer, he/she is said to have a/an a unenforceable contract b individual contract c managed care plan d Both b and c are correct ____ 72 A special tax shelter set up for the purpose of paying medical bills is a a indemnity plan b managed care plan c tax shelter contract d medical savings account ____ 73 Most third-party payers do not pay for medical services that are a diagnostic in nature b considered outdated c not medically necessary d provided in another state ____ 74 A _____ provider is one who contracts with the insurer, agreeing to abide by certain rules and regulations of that carrier a participating b non-participating c managed healthcare d fee-for-service True/False Indicate whether the statement is true or false ____ 75 Healthcare providers and companies that sell insurance have determined it is less costly to prevent serious illnesses than to treat them after they emerge ____ 76 Justin Ford Kimball introduced a health plan in Dallas in 1929 that evolved into what today is known as Medicare ____ 77 Usually, there are no deductibles to be met or claim forms to be completed with HMOs ____ 78 An option for people who are unable to acquire healthcare coverage through their employers is purchasing a healthcare policy through private insurance carriers ____ 79 Under HIPAA, employees who quit their jobs or are laid off can extend their group healthcare coverage for up to 36 months ____ 80 One of the factors that drives up healthcare costs is the fact that Americans are living longer than ever before ____ 81 Media coverage is instrumental in keeping healthcare costs down ____ 82 People need health insurance in order to protect themselves from possible financial ruin ____ 83 Medicare provides healthcare coverage for qualifying low-income individuals ____ 84 The two basic types of health insurance plans are indemnity and managed care ____ 85 The ability to effectively perform one’s job without direct supervision is called autonomy ____ 86 Professional ethics are moral principles that are associated with a specific vocation ____ 87 Advancement opportunities as a health insurance professional are relatively limited ____ 88 Health insurance professionals who are also certified coders can expect higher wages ____ 89 The basic goal of a health insurance professional is to ensure that providers and patients get paid correctly in a timely manner ____ 90 There are as many different insurance claim forms as there are insurance companies ____ 91 Certification is the culmination of a process of formal recognition of the competence possessed by an individual in a specific area ____ 92 One can typically expect to perform various duties when one becomes a health insurance professional ____ 93 The nationally recognized title for a health insurance professional is “insurance biller/coder” ____ 94 Computers have dramatically changed the face of health insurance ____ 95 Health insurance professionals are currently in high demand in the United States ____ 96 One of HIPAA’s goals is to reduce the number of forms and methods of completing insurance claims ____ 97 The primary goal of the health insurance professional is to complete and submit insurance claims ____ 98 Since insurance is not a universal concern, health insurance professionals do not need to worry about legal issues ____ 99 Medical law and liability is the same in all 50 states ____ 100 A contract must be legal before it can be enforced ____ 101 Under no circumstances can a minor enter into a legally binding contract ____ 102 A patient can terminate the doctor/patient contract simply by paying the bill and not returning to the practice ____ 103 In today’s healthcare environment, patients are frequently referred to as customers ____ 104 HIPAA’s regulations affect only healthcare issues ____ 105 Businesses have the same obligation to protect medical records as medical practices ____ 106 A medical record serves only one purpose—to chronologically document a patient’s healthcare treatment ____ 107 All 50 states have a mandatory, 5-year retention of records law ____ 108 It is generally an accepted fact that medical records are the property of the healthcare facility ____ 109 There is a subtle distinction between “privacy” and “confidentiality” ____ 110 A patient who is being treated for an injury as a result of an accident on the job is not required to sign a release of information ____ 111 HIPAA affects various categories of people/businesses involved with healthcare ____ 112 Day-to-day contact with patients presents continuous ethical and legal responsibilities for the health insurance professional ____ 113 A three-way contract exists between the physician, the patient, and the insurance carrier ____ 114 A medical record is not a legal document ____ 115 Timely, complete, and accurate documentation is an important factor in quality patient care ____ 116 It is illegal for the health insurance professional to make any documentation entries in a patient’s health record ____ 117 Under no circumstance may information in a patient’s record be released with the express written authorization by the patient or his/her parent/guardian ____ 118 The terms fraud and abuse are interchangeable ____ 119 Child abuse, but not the abuse of an adult, is an exception to confidentiality ____ 120 The Federal False Claim Amendments Act (of 1986) expands the government’s ability to control fraud and abuse in healthcare ____ 121 COBRA affects employers with more than 20 employees ____ 122 Medicare supplement policies are frequently called Medigap policies ____ 123 Medicaid is administered solely by the federal government ____ 124 TRICARE is the US military’s comprehensive healthcare program for active duty and retired personnel ____ 125 Disability insurance is the same as workers’ compensation ____ 126 SSDI is an insurance program that only individuals over 65 can qualify for ____ 127 Flexible spending accounts (FSAs) are “cafeteria” plans, meaning premiums are deducted from the employee’s wages before withholding taxes are deducted ____ 128 Long-term care insurance covers nursing home care ____ 129 The “birthday rule” is an informal procedure used to determine which plan is “primary” when individuals are listed as dependents on more than one policy ____ 130 Insurance reimbursement is typically based on “medical necessity” ____ 131 UCR fees for commercial insurers are established by the federal government ____ 132 One advantage of group health insurance is that there is usually no preexisting condition exemption ____ 133 COBRA is the federal act that mandates Medicare beneficiaries purchase a Medigap policy Completion Complete each statement 134 The amount of money an individual pays in return for health insurance coverage is called a/an ____________________ 135 Rhodes’ extensive code of sea laws included the principle of ____________________ or “general average” 136 In 1850, the Franklin Health Assurance Company began offering medical expense coverage, similar to today’s health insurance, in the state of ____________________ 137 The out-of-pocket expense that patients must pay before insurers begin paying benefits is called a/an ____________________ 138 A condition or illness that is in existence when an individual’s healthcare coverage begins is called a/an ____________________ 139 The type of healthcare policy that a business entity frequently offers its employees is called a/an ___________________ policy 140 Healthcare plans that provide cost-effective care while attempting to contain expenditures is referred to as ____________________ 141 The two major sources of health insurance are ___________________ programs and ___________________ organizations 142 The two basic types of healthcare are ___________________ and ____________________ 143 The federal act that allows employees who quit their jobs or get laid off to extend their group coverage is known by the acronym ___________________ 144 Direct and indirect patient contact involves ____________________ and ____________________ responsibilities 145 Legal form is only applicable in ____________________ contracts 146 To be HIPAA-compliant, a medical facility should develop and maintain a 7-step ____________________ 147 When an individual has the legal ability to handle another person’s affairs, he/she is said to have ____________________ Matching Match each item with the correct staement below a COBRA b copayment c deductible d fee-for-service e FSA f group plan g Medicaid h medically necessary i Medicare j nonPAR provider k PAR provider l UCR m workers’ compensation ____ 148 The amount of money paid upfront each year before benefits begin ____ 149 The “traditional” type of insurance plan ____ 150 A type of healthcare policy available to corporate employees ____ 151 The joint federal/state program for low-income individuals ____ 152 The type of insurance that pays employees who become ill or are injured on the job ____ 153 A fee structure based on a consensus of what most physicians charge for a similar procedure in the same geographic area ____ 154 Services, procedures, or supplies that meet specific criteria necessary for patient treatment ____ 155 A physician who contracts with the third-party payer and agrees to abide by certain rules set down by the payer ____ 156 The federal act that allows workers who lose their insurance benefits the right to continue group coverage temporarily ____ 157 An IRS Section 125 cafeteria plan Short Answer 158 List four types of business entities who typically hire health insurance professionals 159 List six typical job responsibilities of a health insurance specialist 160 Name four areas of certification available to the health insurance professional 161 List six on-the-job skills that a health insurance professional should possess 162 List the five elements of a legal contract 163 List six ethical areas in healthcare 164 List HIPAA’s four primary objectives 165 List four purposes of a medical record Insurance Basics - Answer Section MULTIPLE CHOICE B PTS: 1 2 A PTS: 1 3 C PTS: 1 4 D PTS: 1 5 A PTS: 1 6 B PTS: 1 7 A PTS: 1 8 C PTS: 1 9 C PTS: 1 10 A PTS: 1 11 D PTS: 1 12 C PTS: 1 13 A PTS: 1 14 B PTS: 1 15 C PTS: 1 16 B PTS: 1 17 C PTS: 1 18 A PTS: 1 19 D PTS: 1 20 A PTS: 1 21 D PTS: 1 22 C PTS: 1 23 A PTS: 1 24 A PTS: 1 25 B PTS: 1 26 D PTS: 1 27 A PTS: 1 28 D PTS: 1 29 D PTS: 1 30 B PTS: 1 31 D PTS: 1 32 C PTS: 1 33 A PTS: 1 34 A PTS: 1 35 C PTS: 1 36 D PTS: 1 37 A PTS: 1 38 C PTS: 1 39 C PTS: 1 40 B PTS: 1 41 C PTS: 1 42 A PTS: 1 43 A PTS: 1 44 B PTS: 1 45 B PTS: 1 46 A PTS: 1 47 C PTS: 1 48 D PTS: 1 49 C PTS: 1 50 D PTS: 1 51 B PTS: 1 52 B PTS: 1 53 A PTS: 1 54 B PTS: 1 55 D PTS: 1 56 A PTS: 1 57 C PTS: 1 58 D PTS: 1 59 B PTS: 1 60 D PTS: 1 61 B PTS: 1 62 C PTS: 1 63 B PTS: 1 64 A PTS: 1 65 D PTS: 1 66 B PTS: 1 67 A PTS: 1 68 D PTS: 1 69 A PTS: 1 70 A PTS: 1 71 B PTS: 1 72 D PTS: 1 73 C PTS: 1 74 A PTS: 1 TRUE/FALSE 75 T PTS: 1 76 F PTS: 1 77 T PTS: 1 78 T PTS: 1 79 F PTS: 1 80 T PTS: 1 81 F PTS: 1 82 T PTS: 1 83 F PTS: 1 84 T PTS: 1 85 T PTS: 1 86 T PTS: 1 87 F PTS: 1 88 T PTS: 1 89 T PTS: 1 90 F PTS: 1 91 T PTS: 1 92 T PTS: 1 93 F PTS: 1 94 T PTS: 1 95 T PTS: 1 96 T PTS: 1 97 T PTS: 1 98 F PTS: 1 99 F PTS: 1 100 T PTS: 1 101 F PTS: 1 102 T PTS: 1 103 T PTS: 1 104 F PTS: 1 105 T PTS: 1 106 F PTS: 1 107 F PTS: 1 108 T PTS: 1 109 T PTS: 1 110 T PTS: 1 111 T PTS: 1 112 T PTS: 1 113 F PTS: 1 114 F PTS: 1 115 T PTS: 1 116 F PTS: 1 117 F PTS: 1 118 F PTS: 1 119 F PTS: 1 120 T PTS: 1 121 T PTS: 1 122 T PTS: 1 123 F PTS: 1 124 T PTS: 1 125 F PTS: 1 126 F PTS: 1 127 T PTS: 1 128 T PTS: 1 129 T PTS: 1 130 T PTS: 1 131 F PTS: 1 132 T PTS: 1 133 F PTS: 1 COMPLETION 134 premium PTS: 1 135 jettison PTS: 1 136 Massachusetts PTS: 1 137 deductible PTS: 1 138 preexisting condition PTS: 1 139 group PTS: 1 140 managed healthcare PTS: 1 141 government, private PTS: 1 142 indemnity, managed care fee-for-service, PTS: 1 143 COBRA PTS: 1 144 ethical, legal PTS: 1 145 written PTS: 1 146 compliance plan PTS: 1 147 power of attorney PTS: 1 MATCHING 148 C PTS: 1 149 D PTS: 1 150 F PTS: 1 151 G PTS: 1 152 M PTS: 1 153 L PTS: 1 154 H PTS: 1 155 K PTS: 1 156 A PTS: 1 157 E PTS: 1 SHORT ANSWER 158 ANS: Physician’s or dentist’s offices Hospitals and urgent care facilities Pharmacies Nursing homes Home health Mental health facilities Physical therapy and rehabilitation centers Insurance companies Health maintenance organizations (HMOs) Consulting firms Health data organizations PTS: 1 159 ANS: Scheduling appointments Bookkeeping and other administrative duties Explaining insurance benefits to patients Handling day-to-day medical billing procedures Adhering to each insurance carrier’s guidelines Documenting all activities using correct techniques and medical terminology Completing insurance forms promptly and accurately Knowing and complying with laws and regulations Computer data entry Interpreting explanation of benefits (EOBs) Posting payments to patient accounts Corresponding with patients and insurance companies PTS: 1 160 ANS: American Academy of Professional Coders (AAPC) Certified Professional Coder (CPC) Certified Professional Coder for Hospitals (CPC-H) American Health Information Management Association (AHIMA) Certified Coding Specialist (CCS) Certified Coding Associate (CCA) Certified Coding Specialist for Physicians (CCS-P) PTS: 1 161 ANS: Pay attention to detail Follow directions Work independently without supervision Understand the need for and possess a strong sense of professional ethics Understand the need for and possess strong people skills Demonstrate patience and an even temperament Be empathetic without being sympathetic Be organized but flexible Be conscientious Demonstrate a sense of responsibility Possess manual dexterity Understand and respect the importance of confidentiality Demonstrate a willingness to learn PTS: 1 162 ANS: offer and acceptance, consideration, legal object, competent parties, legal form PTS: 1 163 ANS: birth control, abortion, experimentation, prolongation of life, quality of life, euthanasia (The complete list can be found at the top of p 32) PTS: 1 164 ANS: to ensure health insurance portability, reduce healthcare fraud and abuse, enforce standards for health information, and guarantee the security/privacy of patients’ health information PTS: 1 165 ANS: to enable physicians to render good medical care, provide statistical information for research; offer legal protection for the healthcare team, and provide support for third-party reimbursement PTS: 1