Healthcare Reimbursements Midterm
Exam-Graded A
In this healthcare delivery model, the government is the only payer that funds universal
healthcare coverage through taxes:
A. Social insurance model
B. National health service model
C. Private health insurance model
D. Cash model - ANSWER-B. National health service model
In this healthcare delivery model, the insurance company determines that contribution
amount that is not based on the policyholder's income:
A. Social insurance model
B. National health service model
C. Private health insurance model
D. Cash model - ANSWER-C. Private health insurance model
In this healthcare delivery model, employees and employers contribute an income-
based amount of money to funds that are regulated by the government:
A. Social insurance model
B. National health service model
C. Private health insurance model
D. Cash model - ANSWER-A. Social insurance model
The US healthcare sector represents a significant portion of the US economy. The trend
of 1 x spending on healthcare has been consistent for more than a decade.
A. Steady
B. Decreased
C. Increased - ANSWER-C. Increased
An employee paying for 40 percent of the insurance premium through payroll
processing is an example of a transaction between 1 x and 2 x .
A. Patient; provider
B. Employer; third-party payer
C. Patient; third-party payer
D. Patient; employer - ANSWER-D. Patient; employer
A physician office submitting an invoice (claim) for payment when the patient has health
insurance is an example of a transaction between 1 x and 2 x .
A. Provider; third-party payer
B. Employer; third-party payer
,C. Patient; third-party payer
D. Patient; employer - ANSWER-A. Provider; third-party payer
Why do health insurers pool premium payments for all the insureds in a group and use
actuarial data to calculate the group's premiums?
A. To increase premium payments for insurance plan payers
B. To simplify accounting for the group's plan
C. To assure that the pool is large enough to pay losses of the entire group
D. To complicate accounting for the group's plan - ANSWER-C. To assure that the pool
is large enough to pay losses of the entire group
Dr. Gilbert sees a 14-old-male with adolescent idiopathic thoracic scoliosis. Surgery for
spinal fusion was canceled after the patient was diagnosed with mononucleosis. On
today's visit, the patient is started on prednisone for severe sore throat and difficulty
swallowing. The patient was accompanied by his parents who have health insurance
through the mother's employment at the State Department of Treasury. Who is the first
party in this healthcare reimbursement scenario?
A. Patient
B. Parents
C. Dr. Gilbert
D. Insurance company - ANSWER-B. Parents
Dr. Gilbert sees a 14-old-male with adolescent idiopathic thoracic scoliosis. Surgery for
spinal fusion was cancelled after the patient was diagnosed with mononucleosis. On
today's visit the patient is started on prednisone for severe sore throat and difficulty
swallowing. The patient was accompanied by his parents who have health insurance
through the mother's employment at the State Department of Treasury. Who is the
second party in this healthcare reimbursement scenario?
A. Patient
B. Parents
C. Dr. Gilbert - ANSWER-C. Dr. Gilbert
Dr. Gilbert sees a 14-old-male with adolescent idiopathic thoracic scoliosis. Surgery for
spinal fusion was cancelled after the patient was diagnosed with mononucleosis. On
today's visit the patient is started on prednisone for severe sore throat and difficulty
swallowing. The patient was accompanied by his parents who have health insurance
through the mother's employment at the State Department of Treasury. Who is the third
party in this healthcare reimbursement scenario?
A. Patient
B. Parents
C. Insurance company - ANSWER-C. Insurance company
Medicaid is a joint program between 1 x and 2 x governments?
A. Federal and county
B. Federal and state
, C. State and city
D. State and county - ANSWER-B. Federal and state
Which government-sponsored program provides coverage for active-duty service
members of the armed forces (ADSM)?
A. TRICARE
B. CHAMPVA
C. Veterans Health Administration
D. Medicare - ANSWER-A. TRICARE
Which government-sponsored program is designed to provide managed care to the frail
elderly population?
A. Medicare Part C
B. State Children's Health Insurance Program (CHIP)
C. Programs of All-Inclusive Care for the Elderly (PACE)
D. Temporary Assistance for Needy Families program (TANF) - ANSWER-C. Programs
of All-Inclusive Care for the Elderly (PACE)
Which of the following is not a function of the Indian Health Service (IHS)?
A. Assists Indian tribes in the development of their own health programs
B. Facilitates and assists Indian tribes in coordinating health planning
C. Provides only inpatient healthcare services
D. Promotes using health resources available at federal, state, and local levels -
ANSWER-C. Provides only inpatient healthcare services
The Civilian Health and Medical Program of the Department of Veterans Affairs
(CHAMPVA) is available for:
A. Veterans of the armed forces
B. Spouse, widow(er), or children of a veteran meeting specific criteria
C. Any spouse, widow(er), or children of a veteran
D. National Guard members - ANSWER-B. Spouse, widow(er), or children of a veteran
meeting specific criteria
Which of the following is(are) true of CHIP?
A. It is a federal and state program
B. It is a state and local program
C. Every CHIP program is identical from state to state
D. It covers individuals 0 to 26 years of age - ANSWER-A. It is a federal and state
program
Which of the following statements about the Veterans Health Administration (VA) is
false?
A. The VA is the nation's largest integrated health care system
B. Basic eligibility includes all veterans who served in active military service regardless
of the separation condition
C. VA provides services at a low cost for its members
Exam-Graded A
In this healthcare delivery model, the government is the only payer that funds universal
healthcare coverage through taxes:
A. Social insurance model
B. National health service model
C. Private health insurance model
D. Cash model - ANSWER-B. National health service model
In this healthcare delivery model, the insurance company determines that contribution
amount that is not based on the policyholder's income:
A. Social insurance model
B. National health service model
C. Private health insurance model
D. Cash model - ANSWER-C. Private health insurance model
In this healthcare delivery model, employees and employers contribute an income-
based amount of money to funds that are regulated by the government:
A. Social insurance model
B. National health service model
C. Private health insurance model
D. Cash model - ANSWER-A. Social insurance model
The US healthcare sector represents a significant portion of the US economy. The trend
of 1 x spending on healthcare has been consistent for more than a decade.
A. Steady
B. Decreased
C. Increased - ANSWER-C. Increased
An employee paying for 40 percent of the insurance premium through payroll
processing is an example of a transaction between 1 x and 2 x .
A. Patient; provider
B. Employer; third-party payer
C. Patient; third-party payer
D. Patient; employer - ANSWER-D. Patient; employer
A physician office submitting an invoice (claim) for payment when the patient has health
insurance is an example of a transaction between 1 x and 2 x .
A. Provider; third-party payer
B. Employer; third-party payer
,C. Patient; third-party payer
D. Patient; employer - ANSWER-A. Provider; third-party payer
Why do health insurers pool premium payments for all the insureds in a group and use
actuarial data to calculate the group's premiums?
A. To increase premium payments for insurance plan payers
B. To simplify accounting for the group's plan
C. To assure that the pool is large enough to pay losses of the entire group
D. To complicate accounting for the group's plan - ANSWER-C. To assure that the pool
is large enough to pay losses of the entire group
Dr. Gilbert sees a 14-old-male with adolescent idiopathic thoracic scoliosis. Surgery for
spinal fusion was canceled after the patient was diagnosed with mononucleosis. On
today's visit, the patient is started on prednisone for severe sore throat and difficulty
swallowing. The patient was accompanied by his parents who have health insurance
through the mother's employment at the State Department of Treasury. Who is the first
party in this healthcare reimbursement scenario?
A. Patient
B. Parents
C. Dr. Gilbert
D. Insurance company - ANSWER-B. Parents
Dr. Gilbert sees a 14-old-male with adolescent idiopathic thoracic scoliosis. Surgery for
spinal fusion was cancelled after the patient was diagnosed with mononucleosis. On
today's visit the patient is started on prednisone for severe sore throat and difficulty
swallowing. The patient was accompanied by his parents who have health insurance
through the mother's employment at the State Department of Treasury. Who is the
second party in this healthcare reimbursement scenario?
A. Patient
B. Parents
C. Dr. Gilbert - ANSWER-C. Dr. Gilbert
Dr. Gilbert sees a 14-old-male with adolescent idiopathic thoracic scoliosis. Surgery for
spinal fusion was cancelled after the patient was diagnosed with mononucleosis. On
today's visit the patient is started on prednisone for severe sore throat and difficulty
swallowing. The patient was accompanied by his parents who have health insurance
through the mother's employment at the State Department of Treasury. Who is the third
party in this healthcare reimbursement scenario?
A. Patient
B. Parents
C. Insurance company - ANSWER-C. Insurance company
Medicaid is a joint program between 1 x and 2 x governments?
A. Federal and county
B. Federal and state
, C. State and city
D. State and county - ANSWER-B. Federal and state
Which government-sponsored program provides coverage for active-duty service
members of the armed forces (ADSM)?
A. TRICARE
B. CHAMPVA
C. Veterans Health Administration
D. Medicare - ANSWER-A. TRICARE
Which government-sponsored program is designed to provide managed care to the frail
elderly population?
A. Medicare Part C
B. State Children's Health Insurance Program (CHIP)
C. Programs of All-Inclusive Care for the Elderly (PACE)
D. Temporary Assistance for Needy Families program (TANF) - ANSWER-C. Programs
of All-Inclusive Care for the Elderly (PACE)
Which of the following is not a function of the Indian Health Service (IHS)?
A. Assists Indian tribes in the development of their own health programs
B. Facilitates and assists Indian tribes in coordinating health planning
C. Provides only inpatient healthcare services
D. Promotes using health resources available at federal, state, and local levels -
ANSWER-C. Provides only inpatient healthcare services
The Civilian Health and Medical Program of the Department of Veterans Affairs
(CHAMPVA) is available for:
A. Veterans of the armed forces
B. Spouse, widow(er), or children of a veteran meeting specific criteria
C. Any spouse, widow(er), or children of a veteran
D. National Guard members - ANSWER-B. Spouse, widow(er), or children of a veteran
meeting specific criteria
Which of the following is(are) true of CHIP?
A. It is a federal and state program
B. It is a state and local program
C. Every CHIP program is identical from state to state
D. It covers individuals 0 to 26 years of age - ANSWER-A. It is a federal and state
program
Which of the following statements about the Veterans Health Administration (VA) is
false?
A. The VA is the nation's largest integrated health care system
B. Basic eligibility includes all veterans who served in active military service regardless
of the separation condition
C. VA provides services at a low cost for its members
