©THEBRIGHT EXAM STUDY SOLUTIONS 8/27/2024 12:01 PM
Kinn's The Administrative Medical Assistant
- Chapter 16 Basics of Health Insurance.
Exams Questions With Correct Answers.
An alphanumeric number issued by the insurance company giving approval of a procedure or
service is a(n) ___________. - answer✔✔authorization code
The amount payable by an insurance company for a monetary loss to an individual insured by
that company, under each coverage, is known as _________. - answer✔✔benefits
In the United States, healthcare practitioners render services ______________ receiving
payment. - answer✔✔prior to
Active duty military personnel, family members, military retirees and their eligible family
members under the age of 65, and the survivors of all uniformed services are covered by
___________. - answer✔✔TRICARE
The health benefits program run by the Department of Veterans Affairs (VA) that helps eligible
beneficiaries pay the cost of specific healthcare services and supplies is the (give
acronym)________________. - answer✔✔CHAMPVA
___________________ provides periodic payments to replace income when an insured person is
unable to work as a result of illness, injury, or disease. - answer✔✔Disability Income Insurance
The ___________________ is the date on which the insurance coverage begins so that benefits
are payable. - answer✔✔Effective date
___________________________ is the process of confirming health insurance coverage for the
patient for the medical service and the date of service. - answer✔✔Verification of Eligibility
The term for limitations on an insurance contract for which benefits are not payable is
__________________. - answer✔✔exclusions
A reimbursement model in which the health plan pays the provider's fee for every health
insurance claim is called ________________. - answer✔✔Fee-for-service or Indemnity plan
, ©THEBRIGHT EXAM STUDY SOLUTIONS 8/27/2024 12:01 PM
Medicaid and Medicare are examples of ________________ plans. - answer✔✔Government-
sponsored
A privately sponsored health plan purchased by an employer for their employees is considered
a(n) ____________________ policy. - answer✔✔Employer-sponsored group
___________________ is a third-party system that reimburses a provider when services are
rendered for an insured patient. - answer✔✔Health insurance
A(n) ______________ is a healthcare plan that controls the cost of healthcare delivery by
requiring all patients to seek care with a primary care provider to assess if more specialized care
is needed. - answer✔✔Health Maintenance Organization (HMO)
_________________ pay for all or a share of the cost of covered services, regardless of which
physician, hospital, or other licensed healthcare provider is used. Policyholders of these plans
and their dependents choose when and where to get healthcare services. - answer✔✔Indemnity
plans
A(n) __________ is health insurance coverage for those who are not covered by their employer
group plan. - answer✔✔Individual health insurance
An umbrella term for all healthcare plans that focus on reducing the cost of delivering quality
care to patient members in return for scheduled payments and coordinated care through a defined
network of primary care physicians and hospitals is _________________. - answer✔✔Managed
Care Plan
A(n) _______________ is a healthcare provider who enters into a contract with a specific
insurance company or program and agrees to accept the contracted fee schedule. -
answer✔✔participating provider
________________ is a process required by some insurance carriers in which the provider
obtains authorization to perform certain procedures or services or to refer a patient to a specialist.
- answer✔✔Preauthorization
A payment of a specific sum of money to an insurance company for a list of health insurance
benefits is called a(n) _____________________. - answer✔✔premium
The primary care provider who can approve or deny when a patient seeks additional care is
referred to as a(n) _____________ - answer✔✔gatekeeper
An insurance term used when a primary care provider wants to send a patient to a specialist is
______________. - answer✔✔referral
The fee schedule designed to provide national uniform payment of Medicare benefits after
adjustment to reflect the differences in practice costs across geographic areas is called the
Kinn's The Administrative Medical Assistant
- Chapter 16 Basics of Health Insurance.
Exams Questions With Correct Answers.
An alphanumeric number issued by the insurance company giving approval of a procedure or
service is a(n) ___________. - answer✔✔authorization code
The amount payable by an insurance company for a monetary loss to an individual insured by
that company, under each coverage, is known as _________. - answer✔✔benefits
In the United States, healthcare practitioners render services ______________ receiving
payment. - answer✔✔prior to
Active duty military personnel, family members, military retirees and their eligible family
members under the age of 65, and the survivors of all uniformed services are covered by
___________. - answer✔✔TRICARE
The health benefits program run by the Department of Veterans Affairs (VA) that helps eligible
beneficiaries pay the cost of specific healthcare services and supplies is the (give
acronym)________________. - answer✔✔CHAMPVA
___________________ provides periodic payments to replace income when an insured person is
unable to work as a result of illness, injury, or disease. - answer✔✔Disability Income Insurance
The ___________________ is the date on which the insurance coverage begins so that benefits
are payable. - answer✔✔Effective date
___________________________ is the process of confirming health insurance coverage for the
patient for the medical service and the date of service. - answer✔✔Verification of Eligibility
The term for limitations on an insurance contract for which benefits are not payable is
__________________. - answer✔✔exclusions
A reimbursement model in which the health plan pays the provider's fee for every health
insurance claim is called ________________. - answer✔✔Fee-for-service or Indemnity plan
, ©THEBRIGHT EXAM STUDY SOLUTIONS 8/27/2024 12:01 PM
Medicaid and Medicare are examples of ________________ plans. - answer✔✔Government-
sponsored
A privately sponsored health plan purchased by an employer for their employees is considered
a(n) ____________________ policy. - answer✔✔Employer-sponsored group
___________________ is a third-party system that reimburses a provider when services are
rendered for an insured patient. - answer✔✔Health insurance
A(n) ______________ is a healthcare plan that controls the cost of healthcare delivery by
requiring all patients to seek care with a primary care provider to assess if more specialized care
is needed. - answer✔✔Health Maintenance Organization (HMO)
_________________ pay for all or a share of the cost of covered services, regardless of which
physician, hospital, or other licensed healthcare provider is used. Policyholders of these plans
and their dependents choose when and where to get healthcare services. - answer✔✔Indemnity
plans
A(n) __________ is health insurance coverage for those who are not covered by their employer
group plan. - answer✔✔Individual health insurance
An umbrella term for all healthcare plans that focus on reducing the cost of delivering quality
care to patient members in return for scheduled payments and coordinated care through a defined
network of primary care physicians and hospitals is _________________. - answer✔✔Managed
Care Plan
A(n) _______________ is a healthcare provider who enters into a contract with a specific
insurance company or program and agrees to accept the contracted fee schedule. -
answer✔✔participating provider
________________ is a process required by some insurance carriers in which the provider
obtains authorization to perform certain procedures or services or to refer a patient to a specialist.
- answer✔✔Preauthorization
A payment of a specific sum of money to an insurance company for a list of health insurance
benefits is called a(n) _____________________. - answer✔✔premium
The primary care provider who can approve or deny when a patient seeks additional care is
referred to as a(n) _____________ - answer✔✔gatekeeper
An insurance term used when a primary care provider wants to send a patient to a specialist is
______________. - answer✔✔referral
The fee schedule designed to provide national uniform payment of Medicare benefits after
adjustment to reflect the differences in practice costs across geographic areas is called the
