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Patients who enroll in the POS type of HMO plan may use the services for: in-network and out-of-network providers TERM 2 What advantages are offered in managed care plans compared to indemnity plans? DEFINITION 2 lower premiums lower charges lower deductibles TERM 3 What is Medicare? DEFINITION 3 Medicare covers patients who are over age 65 TERM 4 True or False? Under an indemnity plan, patients may use services of any provider DEFINITION 4 True TERM 5 Name the 2 components of a CDHP DEFINITION 5 A health plan and a special savings account
define certification recognition of a superior level of skill by an official organization TERM 7 How do costs of writing a policy for a group differ from individual policies? DEFINITION 7 Policies written for groups are cheaper TERM 8 For a fee-for-service plan, does the third-party payer pay before or after a medical service DEFINITION 8 Fee-for-service plans are retroactivemeaning third- party payers pay after a medical service TERM 9 The capitated rate per member per month covers... DEFINITION 9 services listed of the schedule of benefits TERM 10 True or False Outpatient surgery is a medical service that is not considered to be a preventive medical service. DEFINITION 10 True
Approximately what percentage of the population are covered under the (IHP) individual health plans? 10% TERM 17 True or False MCO require referrals to be made to either participating and non- participating providers DEFINITION 17 False; the correct answer is MCO require referrals to be made to ONLY participating providers TERM 18 True or False it is common for a physician to participate in more than 20 health plans DEFINITION 18 True TERM 19 What type of payment structure that PPO's usually offer in their contracts with providers called? DEFINITION 19 Discounted fee-for-service TERM 20 BlueCross and BlueShield companies also offer a CDHP called? DEFINITION 20 Flexible Blue
True or False A tiered network reimburses more for quality, cost-effective care. True TERM 22 What is a host plan? DEFINITION 22 After providing treatment, the provider submits the claim to the local BCBS plan in his or her service plan is referred as the host plan. TERM 23 What is the health insurance program for federal government employees? DEFINITION 23 FEHB TERM 24 eligible members of a capitated plan are listed on the? DEFINITION 24 monthly enrollment list TERM 25 What is the nation's largest insurer in the terms of enrollment? DEFINITION 25 WellPoint, Inc.
Which Part of Medicare provides coverage for artificial eyes? Medicare Part B TERM 32 Medicare requires which coding set for services? DEFINITION 32 CPT/HCPCS TERM 33 Which part of Medicare provides coverage for immunizations? DEFINITION 33 Medicare Part B TERM 34 True or False Outpatient hospital benefits are provided under Medicare Part B DEFINITION 34 True TERM 35 Who issues the Medicare insurance cards for Medicare enrollees? DEFINITION 35 Social Security Administration
True or False Anyone over age 65 who receives social security benefits is automatically enrolled in Medicare Part A and is eligible to enroll in Medicare Part B True TERM 37 What part of Medicare provides coverage for home healthcare? DEFINITION 37 Medicare Part A TERM 38 What part of Medicare offers a prescription drug plan? DEFINITION 38 Medicare Part D TERM 39 Roster billing applies which part of Medicare? DEFINITION 39 Medicare Part B TERM 40 True or False Hospital benefits are provided by Medicare Part A DEFINITION 40 True
True or False Medicare does not usually cover custodial services, long-term care, or acupunture True TERM 47 Which part of Medicare provides coverage for DME? DEFINITION 47 Medicare Part B TERM 48 Which part of Medicare provides coverage for hospice? DEFINITION 48 Medicare Part A TERM 49 True or False There is inpatient care services in a skilled nurse facility DEFINITION 49 True TERM 50 What is the HMO process for referrals? DEFINITION 50 most HMOs require all referrals to be provided by the (PCP) Primary Care Physician before seeking specialist care
