Administrative Duties of Medical Assistants: Health Insurance Final Assessment
Directions:
Answer the following questions.
1. At what age do people generally qualify for Medicare?
A. 30 years old
B. 40 years old
C. 65 years old
D. 75 years old
2. What percentage of healthcare bills does TRICARE usually cover?
A. 25 percent
B. 45 percent
C. 75 percent
D. 100 percent
3. Fill in the blanks using the words from the word bank below.
Long-term disability is health insurance coverage for people with a disability which ____________ with their ability to ____________ or perform daily ____________.
|
activities assists |
interferes rest |
work |
4. Which insurance is provided by the government for active or retired military?
A. Private insurance
B. Medicare
C. TRICARE
D. Employer-sponsored insurance
5. Patient co-pays are due at the end of each year.
A. True
B. False
6. Select the correct word choice from the underlined section.
A healthcare provider may contact the health insurance provider to ensure costs will be covered for a procedure. This is called prior authorization / co-payment.
7. In a formulary, medications are broken into tiers and the lower-tier medications cost more.
A. True
B. False
8. Who determines whether a healthcare claim is approved or denied?
A. Patient
B. Physician
C. Medical assistant
D. Health insurance provider
9. Which process occurs when the patient requests a determination reversal on a previously denied claim?
A. Appeal
B. Denial
C. Determination
D. Prior authorization
10. Health insurance gaps may be filled by hospital __________.
A. Financial aid applications
B. Denial
C. Prior authorization
D. Co-pay
11. Which of the following is the set amount of money due each office visit?
A. Group number
B. Plan name
C. Co-pay
D. ID number
12. The different parts of the health insurance card usually include __________.
A. Group number, patient name and patient phone number
B. Plan name, group number, ID number, patient co-pay, co-insurance and phone numbers
C. Name, date of birth and plan name
D. Plan name, ID number and doctor’s name
13. A co-payment is paid by the patient at time of service.
A. True
B. False
14. FQHC stands for which of the following?
A. Federal Quality Health Association
B. Federally Qualified Health Center
C. First Qualified Health Center
D. Financially Qualified Health Center
15. Which health insurance option is beneficial for a person who is hurt on the job?
A. Workers’ compensation
B. Long-term disability
C. Private insurance
D. Employer-sponsored insurance
16. A denial is a determination by the __________ in which the costs are NOT covered.
A. Patient
B. Health insurance provider
C. Hospital employee
D. Employer
17. When one provider sends a form to a specialized care provider for a patient, it is called a(n) __________.
A. Denial
B. Referral
C. Explanation of Benefits
D. Prior Authorization
18. Fill in the blanks using the word bank provided below.
TRICARE has two main plan types: ____________, which requires a referral from a PCP to see specialists, and ____________, which does not require a referral and individuals may seek care anywhere.
|
CHAMPVA Medicare |
PCP prime |
select TRICARE |
19. TRICARE has a nurse hotline, which patients may call to receive phone advice and a referral to urgent care.
A. True
B. False
20. CHAMPVA stands for which of the following?
A. Champions Heart and Medical Providers of the Department of Veterans Affairs
B. Civilian Health and Medical Providers of the Department of Veterans Affairs
C. Civilian Health and Medical Program of the Department of Veterans Affairs
D. Civilian Health and Medical Program of the Department of Veterans Association
