AAPC CPB - Chapter 2 Review 100%
Correct!!
What is the largest health program in the United States?
a. Blue Cross Blue Shield
b. Medicare
c. Medicaid
d. TRICARE - ANSWERSb. Medicare
Which of the following services is NOT covered under Medicare Part B?
a. Cardiovascular disease screening
b. Diabetes self-management
c. Nutrition therapy services
d. Home Health services - ANSWERSd. Home Health services
Health Savings Account (HSA) is ____________________ to employees.
a. tax-free income
b. taxed income
c. a monthly contribution only made by employers
d. only for medical coverage, excluding dental and vision expense - ANSWERSa. tax-
free income
Managed Care Organizations (MCOs) place the physician at financial risk for the care of
the patient and are reimbursed by:
a. Capitation
b. Fee-for-service
c. Reimbursement account
d. Patient payments - ANSWERSa. Capitation
A Medicare patient presents after slipping and falling in a neighbor's walkway. The
cement had a large crack, which caused the pavement to raise and be unsteady. The
neighbor has contacted his homeowner's insurance and they are accepting liability and
have initiated a claim. How should the visit be billed?
a. Bill the Homeowner's insurance only. Medicare will not pay anything.
b. Bill Medicare, then the Homeowner's insurance as secondary.
c. File to both at the same time and see which pays more.
d. Bill the Homeowner's first, then Medicare secondary if it is not paid within 120 days. -
ANSWERSd. Bill the Homeowner's first, then Medicare secondary if it is not paid within
120 days.
, What are some of the ways that managed care organizations (MCOs) offer provisions
that provide insurers with ways to manage the cost, use, and quality of healthcare
services received by a member?
I. Utilization review
II. Coverage restrictions
III. Arbitration
IV. Non-emergency weekend admission restrictions
a. I, IV
b. I, II, IV
c. II, III, IV
d. II, IV - ANSWERSa. I, IV
The 2019 Medicare deductible and co-insurance amount for outpatient services on Part
B is
a. $185 per calendar year and 20% of approved amount
b. $185 per calendar year and 20% of the billed amount
c. $185 per hospitalization and 20% of approved amount
d. $185 per calendar year - ANSWERSa. $185 per calendar year and 20% of approved
amount
A group contracts with a third party administrator to manage paperwork. This group
pays for the operation of the insurance plan and the costs of administration. What type
of plan does this represent?
a. Fully Insured Employer Group
b. Self - Funded ERISA
c. Association Group
d. Management Service Organization - ANSWERSb. Self - Funded ERISA
Which of the following statements is true regarding the key provisions of coverage
under the Affordable Care Act (ACA)?
a. Children under the age of 21 may be eligible to be covered under their parent's health
plan if they are in college.
b. There are 30 covered preventive services for women.
c. Patients have the right to appeal a health plan's decision to deny payment for a claim
or termination of health coverage.
d. Lifetime limits are not banned on any health plans issued. - ANSWERSc. Patients
have the right to appeal a health plan's decision to deny payment for a claim or
termination of health coverage.
Which type of HMO contracts with multiple specialty groups, individual practice groups,
and individual physicians?
Correct!!
What is the largest health program in the United States?
a. Blue Cross Blue Shield
b. Medicare
c. Medicaid
d. TRICARE - ANSWERSb. Medicare
Which of the following services is NOT covered under Medicare Part B?
a. Cardiovascular disease screening
b. Diabetes self-management
c. Nutrition therapy services
d. Home Health services - ANSWERSd. Home Health services
Health Savings Account (HSA) is ____________________ to employees.
a. tax-free income
b. taxed income
c. a monthly contribution only made by employers
d. only for medical coverage, excluding dental and vision expense - ANSWERSa. tax-
free income
Managed Care Organizations (MCOs) place the physician at financial risk for the care of
the patient and are reimbursed by:
a. Capitation
b. Fee-for-service
c. Reimbursement account
d. Patient payments - ANSWERSa. Capitation
A Medicare patient presents after slipping and falling in a neighbor's walkway. The
cement had a large crack, which caused the pavement to raise and be unsteady. The
neighbor has contacted his homeowner's insurance and they are accepting liability and
have initiated a claim. How should the visit be billed?
a. Bill the Homeowner's insurance only. Medicare will not pay anything.
b. Bill Medicare, then the Homeowner's insurance as secondary.
c. File to both at the same time and see which pays more.
d. Bill the Homeowner's first, then Medicare secondary if it is not paid within 120 days. -
ANSWERSd. Bill the Homeowner's first, then Medicare secondary if it is not paid within
120 days.
, What are some of the ways that managed care organizations (MCOs) offer provisions
that provide insurers with ways to manage the cost, use, and quality of healthcare
services received by a member?
I. Utilization review
II. Coverage restrictions
III. Arbitration
IV. Non-emergency weekend admission restrictions
a. I, IV
b. I, II, IV
c. II, III, IV
d. II, IV - ANSWERSa. I, IV
The 2019 Medicare deductible and co-insurance amount for outpatient services on Part
B is
a. $185 per calendar year and 20% of approved amount
b. $185 per calendar year and 20% of the billed amount
c. $185 per hospitalization and 20% of approved amount
d. $185 per calendar year - ANSWERSa. $185 per calendar year and 20% of approved
amount
A group contracts with a third party administrator to manage paperwork. This group
pays for the operation of the insurance plan and the costs of administration. What type
of plan does this represent?
a. Fully Insured Employer Group
b. Self - Funded ERISA
c. Association Group
d. Management Service Organization - ANSWERSb. Self - Funded ERISA
Which of the following statements is true regarding the key provisions of coverage
under the Affordable Care Act (ACA)?
a. Children under the age of 21 may be eligible to be covered under their parent's health
plan if they are in college.
b. There are 30 covered preventive services for women.
c. Patients have the right to appeal a health plan's decision to deny payment for a claim
or termination of health coverage.
d. Lifetime limits are not banned on any health plans issued. - ANSWERSc. Patients
have the right to appeal a health plan's decision to deny payment for a claim or
termination of health coverage.
Which type of HMO contracts with multiple specialty groups, individual practice groups,
and individual physicians?
