Question: Of the federal programs providing healthcare, the largest is ____, which provides health insurance for citizens aged 65 and older.

Answer: Medicare

Question: Who most frequently files insurance claims and handles insurers' payments for a medical practice?

Answer: Medical assistant

Question: The authorization for an insurance carrier to pay the physician or the medical practice directly is the ____.

Answer: assignment of benefits

Question: The person whose name the insurance is carried under is called the ____.

Answer: subscriber

Question: In most cases, the insured person pays an annual cost or ____ for healthcare insurance

Answer: premium

Question: The fixed dollar amount a subscriber must pay or "meet" each year before the insurer begins to cover expenses is the ____.

Answer: deductible

Question: Patients who belong to a managed care health plan, such as an HMO, are responsible for a small per-visit fee collected at the time of the visit. This fee is commonly called a(n) ____.

Answer: copayment

Question: In a typical medical practice, insurance claims are filed ____.

Answer: a few business days after the date of service

Question: The most likely outcome of an insurance claim submitted with a diagnosis code of a sore throat and a treatment code indicating a cast for a broken leg would be ____.

Answer: denied because the treatment was not medically necessary based on the diagnosis

Question: An insurance claims department compares the fee the doctor charges with the benefits provided by the patient's health plan. This is called the ____.

Answer: review for allowable benefits

Question: Which of the following is what the patient owes after the insurance company has paid?

Answer: Patient liability

Question: Which of the following types of insurance covers injuries that are caused by the insured or that occurred on the insured's property?

Answer: Liability

Question: To be covered under Medicare Part B, patients must ____.

Answer: enroll, because coverage is not automatic

Question: A patient who has been hospitalized up to 90 days for each benefit period is covered under ____.

Answer: Medicare Part A

Question: The benefit period for Medicare begins the day a patient goes into the hospital and ends when that patient has not been hospitalized for ____ days.

Answer: 60

Question: Which of the following is a characteristic of Medicaid?

Answer: It is a health cost assistance program.

Question: Patients under the age of 65 who are blind or widowed or who have serious long-term disabilities, such as ____, may be entitled to Medicare.

Answer: kidney failure

Question: Which of the following is included in Medicare benefits for respite care?

Answer: The terminally ill patient is moved to a care facility for the respite.

Question: An organization that provides pain relief to terminally ill patients and supports these patients and their families is a

Answer: hospice

Question: Which of the following statements applies to a physician who agrees to accept Medicaid patients?

Answer: The physician can bill the patient for services that Medicaid does not cover

Question: The amount Medicare pays the physician or healthcare provider after the annual deductible is met is ____.

Answer: 0.8

Question: Which of the following is not part of Medicare's resource-based relative value scale?

Answer: Medigap, to reduce the gap in coverage

Question: Which of the following guidelines is applicable when filing a Medicaid claim and interacting with Medicaid patients?

Answer: Treat the patient as if he or she has private insurance

Question: Which statement is true about TRICARE?

Answer: TRICARE for Life acts as a secondary payer to Medicare

Question: In which program can enrollees who are aged 65 and older continue to obtain medical services at military hospitals and clinics as they did before they turned 65?

Answer: TRICARE for Life