NWCA STUDY GUIDE QUESTIONS
AND ANSWERS LATEST UPDATED
2025/2026
Managed Care Organization (MCO) - ANSWERSCombines functions of health
insurance, delivery of care and administration
Exclusive Provider Organization (EPO) - ANSWERSServices covered only if use
doctors, specialists or hospitals in plans network (except in hospitals)
Health Maintenance Organization (HMO) - ANSWERSLimits coverage to care from
doctors who work for or contract with the HMO, generally won't cover out of network
care except in emergency. May require to live or work in its service area.
Point of Service (POS) - ANSWERSPay less if you use doctors, and other health care
providers that belong to the plans network, required to get a referral from primary care
doctor in order to see specialist
Quality Improvement Organization (QIO) - ANSWERSPhysician can hose whether or
not accept Medicare patients, who are seeking non medical services, signs an
agreement and May sign a participating provider agreement(PAR)
Preferred Provider Organization (PPO) - ANSWERSPay less if use providers in plans
network. Can use providers outside of network without a referral for N additional cost.
DHHS stands for - ANSWERSDepartment of health and human services
DRG assignment - ANSWERSA system of payment rates to health care providers in
which illnesses are categorized into related types
Medicare severity diagnosis related groups (MS-DRG) are used for -
ANSWERSReimbursement decisions
UB04 also called c,s-1450 is - ANSWERSThe insurance form used by inpatient facilities
for claims submissions
Part A, covered in hospital expenses covers - ANSWERSSemiprivate room, meals and
special diets in hospital, all medically necessary services
Part A, non covered in hospital expenses covers, - ANSWERSPersonal convenience
items like slippers or television, non medical necessary items.
AND ANSWERS LATEST UPDATED
2025/2026
Managed Care Organization (MCO) - ANSWERSCombines functions of health
insurance, delivery of care and administration
Exclusive Provider Organization (EPO) - ANSWERSServices covered only if use
doctors, specialists or hospitals in plans network (except in hospitals)
Health Maintenance Organization (HMO) - ANSWERSLimits coverage to care from
doctors who work for or contract with the HMO, generally won't cover out of network
care except in emergency. May require to live or work in its service area.
Point of Service (POS) - ANSWERSPay less if you use doctors, and other health care
providers that belong to the plans network, required to get a referral from primary care
doctor in order to see specialist
Quality Improvement Organization (QIO) - ANSWERSPhysician can hose whether or
not accept Medicare patients, who are seeking non medical services, signs an
agreement and May sign a participating provider agreement(PAR)
Preferred Provider Organization (PPO) - ANSWERSPay less if use providers in plans
network. Can use providers outside of network without a referral for N additional cost.
DHHS stands for - ANSWERSDepartment of health and human services
DRG assignment - ANSWERSA system of payment rates to health care providers in
which illnesses are categorized into related types
Medicare severity diagnosis related groups (MS-DRG) are used for -
ANSWERSReimbursement decisions
UB04 also called c,s-1450 is - ANSWERSThe insurance form used by inpatient facilities
for claims submissions
Part A, covered in hospital expenses covers - ANSWERSSemiprivate room, meals and
special diets in hospital, all medically necessary services
Part A, non covered in hospital expenses covers, - ANSWERSPersonal convenience
items like slippers or television, non medical necessary items.
