A. Yes, because the patient has end-stage renal disease
B. No, because the patient resides in New Mexico
C. No, because the patient is under age 65
D. Yes, because the patient has hypertension
13. The first prepaid health insurance plans in the United States were
A. TRICARE and workers’ compensation.
B. CHAMPUS and CHAMPVA.
C. Blue Cross and Blue Shield.
D. Medicare and Medicaid.
14. Which of the following is the largest privately underwritten health insurance contract in the world?
A. Harless program
B. SCHIP
C. Federal Employee Program (FEP)
D. CHAMPVA program
15. A provider is classified as a/an
A. biller who submits claims to insurance carriers.
B. coder who provides medical record data.
C. individual or group of individuals that provide a health care service.
D. beneficiary that provides information for insurance coverage.
16. Tom is billing an emergency room visit for a Medicaid patient who’s being seen for a wellness visit. Which one of the following statements is true as a result of the Balanced Budget Act?
A. There are new surgical treatments available.
B. No new applications are required for TAFT recipients.
C. Patients have expanded preventive-care benefits.
D. There are new standards for TRICARE.
17. Dr. Singer is working within a reimbursement system in which the insurance is billed after all the treatment has been given to the patients. What is the main reason that the doctor orders more tests, exams, and procedures under this system?
A. Fear of being sued
B. To increase resource utilization
C. To make a profit
D. Because no one has to pay for it
18. With a PPO, the beneficiary has the ability to
A. choose a hospital within a 50-mile radius only.
B. choose a physician or hospital from the designated provider list.
C. select a dentist within a 10-mile radius.
D. select an add-on policy for supplemental unemployment benefits
19. Physician-hospital organizations (PHOs) are also called _______ organizations.
A. medical staff-hospital
B. health management
C. individual provider
D. preferred provider
20. Mrs. Fang is a 72-year-old retired school teacher who has been hospitalized for pneumonia. What type of insurance is most likely being used to pay for her hospital stay?
A. Medicare Part D
B. Medicare Part B
C. Medicare Part A
D. Medicare Part C
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