HSA 3111 EXAM 2 QUESTIONS WITH VERIFIED SOLUTIONS LATEST UPDATE 2026
AMA 1847 - Answers Started the standards for medicine, made western medicine more recognized as
a profession
Flexner Report 1910 - Answers Wrote a report that standardized medical training in medical schools -
outlined shortcomings of these schools
Blue Cross 1929 - Answers Baylor University - hospital based plan (in-patient services only)
SSA 1935 - Answers laid out a framework for later healthcare programs
Blue Shield - 1939 - Answers outpatient services/ambulatory care
Post WW2 1946 - Answers big push for employer based insruance - cemented by tax advantages
SSA 1965 - Answers these admendments estabilished Medicare and Medicaid - Office of Economic
Opportunity
HMO Act 1973 - Answers Health Maintenance Organization - Nixon - promoted development of hmos
and standards and required employers to offer these plans
EMTALA 1986 - Answers Emergency Medical Treatment and Labor Act - hospitals have to give you
emergency care regardless of ability to pay
CHIP 1987 - Answers SSA title 21 - childrens health insurance plan for families above medicaid
eligibility
Medicare - Answers 69 M enrolled, annual cost 1.03 T
Medicaid - Answers 70 M enrolled, annual cost 871 B
1956 Social Security Disability Insurance - Answers Pays for long term disability for workers - eligibility:
have a disability, cant work 1 yr, amount based on time/earnings during employment
1965 SSA title 18 - Answers founded medicare, 19 M seniors started recieving on july 1st 1966
1972, 2001 - Expansion of Medicare - Answers Expanded to include end stage renal disease (ESRD) in
1972 and Amyotrophic lateral sclerosis (ALS) in 2001
2003 MMA Act - Answers Medicare Prescription Drug, Improvement, and Modernization Act - created
the Medicare Part D prescription drug benefit - part D only got enacted in 2006
Medicare Choices - Answers you have 6 months to choose: Advantage or Original
Medicare Original - Answers Plans typically include Part A and Part B, optional is medigap-
supplmental and part D
Medicare Advantage - Answers includes part and part b, and most plans also include part D and extra
benefits
1965 - Part A - SSA title 18 - Answers - most americans don't pay a premium on this
- covers inpatient costs
- auto-enrollment
-covers room and board in a hospital for 60 days
-inpatient drugs covered
- deductible is around 1,676
1965 - Part B - SSA title 18 - Answers - outpatient costs
- covers physcian visits
- outpatient drugs
- supplies, equipment, labs, diagnostic, ambulance, wellness
-premium: 185 a month
deductible: 257
Medi-gap supplment 1980 - Answers - created to counter rising costs in healthcare
- offset some of the patient costs from parts a&b like copay and deductible
- in order to have medigap u need part B
- private insurance
-premium ranges from 109-298 a month
1997 - Part C - medicare advantage plan - Answers - need part A/B
- insurance companies make payments for you with government money
- HMO/PPO plans
- also includes private fee for service plans and special needs plans
- delay's the penalty
- premium : 0-300, varies in pricing
have to pay both part C and part B premium
, 2003 - Part D - Drugs - Answers - MPD Vs MAPD: You can get Part D coverage in two main ways: either
through a stand-alone prescription drug plan (PDP) to supplement Original Medicare or as part of a
Medicare Advantage (Part C) plan that includes drug coverage (MA-PD)
- premium : 39
deductible : 615
initital 2,000 (25%) at most
catastrophe (0%)
MEdicare eligibility - Answers - be over 65 years old
- have paid payroll + Social security tax for 10 years
- or have ESRD, ALS, or a recognized long-term disability
1965 Ttile 19 : Medicaid - Answers - for familes with children
- age 65 and up
-blind and disabled
SSI 1972 - Answers supplemental security income by Nixon
- individual 967
couple : 1450
1986 - Expandion of medicaid - Answers - now includes pregnant womaen and children (0-1YR)
1997 - CHIP - SSA Title 21 - Answers childrens health insurance program -0-17
2010 - ACA - Answers raised it so to qualify you need to be under 138% of the Federal poverty line
also includes adults without children
Medicaid Traditional - Answers FFS system
state pays providers
Medicaid Managed Care - Answers - managed medical assistance
- long-term care
-dental
- private insurance companies that contract with state Medicaid agencies to provide healthcare
services to Medicaid beneficiaries.
Agency for Health Care Administration - Answers Manages Medicaid
Department of children and families and the Social security administration - Answers determine
eligibility
premium - Answers regular payment that you make to have health insurance
copay - Answers anytime you recieve care at a point of service, you need to pay something (fixed fee)
deductible - Answers amount you need to pay before insurance kicks in
coinsurance - Answers this is where you share burden with your insurance company, ratio applys to
costs after you meet your deductible
OOP maximum - Answers should be at most what you are going to pay that year before insurance
pays 100%
provider network - Answers a group of providers that an insurer has contracted with to provide
services
- Managed care organizations led to this as a way to cut costs in bulk
MCOS 3 types - Answers EPO, HMO, PPO
EPO - Answers Exclusive Provider Organization - plan will not pay for care received outside the system
- usually a smaller network and cheaper
HMO - Answers health maintenance organization - also an exclusive network - plan will not cover
outside network costs
difference between EPO and HMO - Answers HMO requires you to get a referral from PCP to see a
specialist, while EPO doesn't
PPO - Answers Preferred provider organization. A prepaid health insurance plan in which providers
agree to deliver services for discount fees; patients can go to any provider, but using nonparticipating
providers results in higher costs to the patient
- bigger network - more freedom to choose providers
- more expensive
Step 1 of the medical billing process - Answers Pre-appointment
patient: makes appt
Provider: makes sure patient has an insurance that they accept
step 2 of the medical billing process - Answers Point of care:
AMA 1847 - Answers Started the standards for medicine, made western medicine more recognized as
a profession
Flexner Report 1910 - Answers Wrote a report that standardized medical training in medical schools -
outlined shortcomings of these schools
Blue Cross 1929 - Answers Baylor University - hospital based plan (in-patient services only)
SSA 1935 - Answers laid out a framework for later healthcare programs
Blue Shield - 1939 - Answers outpatient services/ambulatory care
Post WW2 1946 - Answers big push for employer based insruance - cemented by tax advantages
SSA 1965 - Answers these admendments estabilished Medicare and Medicaid - Office of Economic
Opportunity
HMO Act 1973 - Answers Health Maintenance Organization - Nixon - promoted development of hmos
and standards and required employers to offer these plans
EMTALA 1986 - Answers Emergency Medical Treatment and Labor Act - hospitals have to give you
emergency care regardless of ability to pay
CHIP 1987 - Answers SSA title 21 - childrens health insurance plan for families above medicaid
eligibility
Medicare - Answers 69 M enrolled, annual cost 1.03 T
Medicaid - Answers 70 M enrolled, annual cost 871 B
1956 Social Security Disability Insurance - Answers Pays for long term disability for workers - eligibility:
have a disability, cant work 1 yr, amount based on time/earnings during employment
1965 SSA title 18 - Answers founded medicare, 19 M seniors started recieving on july 1st 1966
1972, 2001 - Expansion of Medicare - Answers Expanded to include end stage renal disease (ESRD) in
1972 and Amyotrophic lateral sclerosis (ALS) in 2001
2003 MMA Act - Answers Medicare Prescription Drug, Improvement, and Modernization Act - created
the Medicare Part D prescription drug benefit - part D only got enacted in 2006
Medicare Choices - Answers you have 6 months to choose: Advantage or Original
Medicare Original - Answers Plans typically include Part A and Part B, optional is medigap-
supplmental and part D
Medicare Advantage - Answers includes part and part b, and most plans also include part D and extra
benefits
1965 - Part A - SSA title 18 - Answers - most americans don't pay a premium on this
- covers inpatient costs
- auto-enrollment
-covers room and board in a hospital for 60 days
-inpatient drugs covered
- deductible is around 1,676
1965 - Part B - SSA title 18 - Answers - outpatient costs
- covers physcian visits
- outpatient drugs
- supplies, equipment, labs, diagnostic, ambulance, wellness
-premium: 185 a month
deductible: 257
Medi-gap supplment 1980 - Answers - created to counter rising costs in healthcare
- offset some of the patient costs from parts a&b like copay and deductible
- in order to have medigap u need part B
- private insurance
-premium ranges from 109-298 a month
1997 - Part C - medicare advantage plan - Answers - need part A/B
- insurance companies make payments for you with government money
- HMO/PPO plans
- also includes private fee for service plans and special needs plans
- delay's the penalty
- premium : 0-300, varies in pricing
have to pay both part C and part B premium
, 2003 - Part D - Drugs - Answers - MPD Vs MAPD: You can get Part D coverage in two main ways: either
through a stand-alone prescription drug plan (PDP) to supplement Original Medicare or as part of a
Medicare Advantage (Part C) plan that includes drug coverage (MA-PD)
- premium : 39
deductible : 615
initital 2,000 (25%) at most
catastrophe (0%)
MEdicare eligibility - Answers - be over 65 years old
- have paid payroll + Social security tax for 10 years
- or have ESRD, ALS, or a recognized long-term disability
1965 Ttile 19 : Medicaid - Answers - for familes with children
- age 65 and up
-blind and disabled
SSI 1972 - Answers supplemental security income by Nixon
- individual 967
couple : 1450
1986 - Expandion of medicaid - Answers - now includes pregnant womaen and children (0-1YR)
1997 - CHIP - SSA Title 21 - Answers childrens health insurance program -0-17
2010 - ACA - Answers raised it so to qualify you need to be under 138% of the Federal poverty line
also includes adults without children
Medicaid Traditional - Answers FFS system
state pays providers
Medicaid Managed Care - Answers - managed medical assistance
- long-term care
-dental
- private insurance companies that contract with state Medicaid agencies to provide healthcare
services to Medicaid beneficiaries.
Agency for Health Care Administration - Answers Manages Medicaid
Department of children and families and the Social security administration - Answers determine
eligibility
premium - Answers regular payment that you make to have health insurance
copay - Answers anytime you recieve care at a point of service, you need to pay something (fixed fee)
deductible - Answers amount you need to pay before insurance kicks in
coinsurance - Answers this is where you share burden with your insurance company, ratio applys to
costs after you meet your deductible
OOP maximum - Answers should be at most what you are going to pay that year before insurance
pays 100%
provider network - Answers a group of providers that an insurer has contracted with to provide
services
- Managed care organizations led to this as a way to cut costs in bulk
MCOS 3 types - Answers EPO, HMO, PPO
EPO - Answers Exclusive Provider Organization - plan will not pay for care received outside the system
- usually a smaller network and cheaper
HMO - Answers health maintenance organization - also an exclusive network - plan will not cover
outside network costs
difference between EPO and HMO - Answers HMO requires you to get a referral from PCP to see a
specialist, while EPO doesn't
PPO - Answers Preferred provider organization. A prepaid health insurance plan in which providers
agree to deliver services for discount fees; patients can go to any provider, but using nonparticipating
providers results in higher costs to the patient
- bigger network - more freedom to choose providers
- more expensive
Step 1 of the medical billing process - Answers Pre-appointment
patient: makes appt
Provider: makes sure patient has an insurance that they accept
step 2 of the medical billing process - Answers Point of care:
