Imperial College Main Exam - CHAPTER
2: QUESTIONS & Answers
a. Medicare
b. Medicaid
c. TRICARE
d. BCBS - ANSWERSc. TRICARE
A Medicaid patient presents for services on the first day of the month. He has a $50
spenddown and has had no services this month. The visit for today was $100.00. If the
patient wants to be covered as long as possible from today's visit, what can he do?
a. Turn the receipt in to his caseworker and be eligible for two months of coverage
b. Turn the receipt in to his caseworker and be eligible for the month with $50 to
assessed by Medicaid for the visit that is above his spenddown
c. Coverage is automatic and the patient will be reimbursed the $100 from Medicaid
d. Turn in the receipt to his caseworker and be eligible for coverage for the current
month, plus two additional months - ANSWERSa. Turn the receipt in to his caseworker
and be eligible for two months of coverage
(A bill that is larger than the spenddown may be used to meet multiple month's
spenddown. If a patient wants the most coverage possible, $100 would meet two
month's coverage spenddown.)
An internist sees a 20-year-old patient for an office visit. The patient needs to see an
endocrinologist for a consultation regarding her diabetes. The internist is a participating
provider in her plan. She can choose any provider she wishes for her consultations, but
she will save money if she sees a specialist that is in her network. She does not require
a referral for her consultation. What type of insurance does the patient have?
a. HMO
b. Indemnity insurance
c. Medicare Advantage
d. PPO - ANSWERSd. PPO
Under the Patient Protection and Affordable Care Act (ACA), what is banned?
a. Coverage for children under the age of 26
b. Patient appeal rights
c. Expanded preventative health services
d. Lifetime limits - ANSWERSd. Lifetime limits
, This type of insurance is paid for by employers for employees and takes advantage of
purchasing power of having large member numbers.
a. Individual health plan
b. Group health plan
c. Medicare
d. Medicaid - ANSWERSb. Group health plan
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
What is the benefit of using NPI numbers for payers?
I. It is a single identifier for all payers
II. It contains the providers' birthdates to allow certain identification
III. Each payer can make their own number
IV. It has no personal identifying information in the number
a. I, II
b. III, IV
c. I, II, IV
d. I, IV - ANSWERSd. I, IV
A patient is age 65 and Medicare eligible. The patient signs up for a Medicare Manage
Care plan. When the patient presents for care, claims are sent to:
a. The Medicare Administrative Contractor
b. The patient
c. The Managed Care Plan
d. Both the Managed Care Plan and Medicare Administrative Contractor - ANSWERSc.
The Managed Care Plan
Physician-Hospital Organizations (PHO), Management Service Organization (MSO) and
Integrated Provider Organization (IPO) are examples of what type of healthcare
models?
a. Integrated Delivery Systems
b. Affiliated Healthcare Systems
c. Preferred Provider Organizations
d. Alliance for Healthcare Systems - ANSWERSa. Integrated Delivery Systems
2: QUESTIONS & Answers
a. Medicare
b. Medicaid
c. TRICARE
d. BCBS - ANSWERSc. TRICARE
A Medicaid patient presents for services on the first day of the month. He has a $50
spenddown and has had no services this month. The visit for today was $100.00. If the
patient wants to be covered as long as possible from today's visit, what can he do?
a. Turn the receipt in to his caseworker and be eligible for two months of coverage
b. Turn the receipt in to his caseworker and be eligible for the month with $50 to
assessed by Medicaid for the visit that is above his spenddown
c. Coverage is automatic and the patient will be reimbursed the $100 from Medicaid
d. Turn in the receipt to his caseworker and be eligible for coverage for the current
month, plus two additional months - ANSWERSa. Turn the receipt in to his caseworker
and be eligible for two months of coverage
(A bill that is larger than the spenddown may be used to meet multiple month's
spenddown. If a patient wants the most coverage possible, $100 would meet two
month's coverage spenddown.)
An internist sees a 20-year-old patient for an office visit. The patient needs to see an
endocrinologist for a consultation regarding her diabetes. The internist is a participating
provider in her plan. She can choose any provider she wishes for her consultations, but
she will save money if she sees a specialist that is in her network. She does not require
a referral for her consultation. What type of insurance does the patient have?
a. HMO
b. Indemnity insurance
c. Medicare Advantage
d. PPO - ANSWERSd. PPO
Under the Patient Protection and Affordable Care Act (ACA), what is banned?
a. Coverage for children under the age of 26
b. Patient appeal rights
c. Expanded preventative health services
d. Lifetime limits - ANSWERSd. Lifetime limits
, This type of insurance is paid for by employers for employees and takes advantage of
purchasing power of having large member numbers.
a. Individual health plan
b. Group health plan
c. Medicare
d. Medicaid - ANSWERSb. Group health plan
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
What is the benefit of using NPI numbers for payers?
I. It is a single identifier for all payers
II. It contains the providers' birthdates to allow certain identification
III. Each payer can make their own number
IV. It has no personal identifying information in the number
a. I, II
b. III, IV
c. I, II, IV
d. I, IV - ANSWERSd. I, IV
A patient is age 65 and Medicare eligible. The patient signs up for a Medicare Manage
Care plan. When the patient presents for care, claims are sent to:
a. The Medicare Administrative Contractor
b. The patient
c. The Managed Care Plan
d. Both the Managed Care Plan and Medicare Administrative Contractor - ANSWERSc.
The Managed Care Plan
Physician-Hospital Organizations (PHO), Management Service Organization (MSO) and
Integrated Provider Organization (IPO) are examples of what type of healthcare
models?
a. Integrated Delivery Systems
b. Affiliated Healthcare Systems
c. Preferred Provider Organizations
d. Alliance for Healthcare Systems - ANSWERSa. Integrated Delivery Systems
