Question 1

What might private payers use for a major course of treatment, such as surgery, chemotherapy, and radiation for a patient with cancer?

Accepted Answer

A)   SPD
B)   URO
C)   IPA
D)   P4P

Question 2

Which of the following is the most popular type of group health plan?

Accepted Answer

A)   point-of-service (POS)  plans
B)   health maintenance organizations (HMOs) 
C)   indemnity plans
D)   preferred provider organizations (PPOs)

Question 3

How often do open enrollment periods usually occur?

Accepted Answer

A)   twice per year
B)   once per month
C)   every other year
D)   once per year

Question 4

In submitting paper claims, the best practice is to

Accepted Answer

A)   check with HIPAA for specific instructions regarding a payer.
B)   check with the employer on payer requirements.
C)   check the NUCC instructions.
D)   check with each payer for specific information required on the form as well as the NUCC notes.

Question 5

Which type of consumer-driven health plan funding option is set up by individuals rather than employers?

Accepted Answer

A)   a health savings account (HS
A)  
B)   a flexible savings account (FS
A)  
C)   a medical home model
D)   a health reimbursement account (HR
A)

Question 6

Who may be covered under a GHP?

Accepted Answer

A)   employees, families, and former employees
B)   employees' families only
C)   former employees only
D)   employees and their families

Question 7

Which of the following examples demonstrates subcapitation?

Accepted Answer

A)   an ancillary provider prepays a capitated provider
B)   the patient prepays a capitated provider
C)   the HMO pays a capitated provider
D)   a capitated provider prepays an ancillary provider

Question 8

Which of the following steps comes first in the standard revenue cycle?

Accepted Answer

A)   Check billing compliance.
B)   Prepare and transmit claims.
C)   Establish financial responsibility for a visit.
D)   Preregister patients.

Question 9

Approximately what percentage of all consumers with health insurance are enrolled in a PPO?

Accepted Answer

A)   25%
B)   75%
C)   50%
D)   10%

Question 10

The health insurance program for federal government employees is

Accepted Answer

A)   HCFA.
B)   FEHB.
C)   BEDOR.
D)   ERISA.

Question 11

Stop-loss provisions protect providers against

Accepted Answer

A)   loss of number of patients.
B)   increase in premiums.
C)   malpractice charges.
D)   extreme financial loss.

Question 12

A female member of a CDHP has an HSA fund of $820 and a deductible of $500 (which has not yet been met) , and the HDHP has a 75-25 coinsurance. Calculate the amount this patient would owe after drawing down her HSA if the bill for her services is $2,100.

Accepted Answer

A)   $400
B)   $500
C)   $80
D)   $2,100

Question 13

Which term refers to an individual who enrolls in a health plan after the original enrollment date?

Accepted Answer

A)   late enrollee
B)   group enrollee
C)   COBRA enrollee
D)   waiting period

Question 14

Which of the following is a time between the date of an employee's hire and the earliest effective date of insurance coverage?

Accepted Answer

A)   a waiting period
B)   a deductible
C)   a limit
D)   a premium

Exam 8: Private Payers/BlueCross BlueShield

The health insurance program for federal government employees is

Correct Answer
verified

A female member of a CDHP has an HSA fund of $820 and a deductible of $500 (which has not yet been met) , and the HDHP has a 75-25 coinsurance. Calculate the amount this patient would owe after drawing down her HSA if the bill for her services is $2,100.

Correct Answer
verified

How often do open enrollment periods usually occur?

Correct Answer
verified

Approximately what percentage of all consumers with health insurance are enrolled in a PPO?

Correct Answer
verified

Which of the following examples demonstrates subcapitation?

Correct Answer
verified

Which of the following steps comes first in the standard revenue cycle?

Correct Answer
verified

Which of the following is the most popular type of group health plan?

Correct Answer
verified

In submitting paper claims, the best practice is to

Correct Answer
verified

Which type of consumer-driven health plan funding option is set up by individuals rather than employers?

Correct Answer
verified

Stop-loss provisions protect providers against

Correct Answer
verified

What might private payers use for a major course of treatment, such as surgery, chemotherapy, and radiation for a patient with cancer?

Correct Answer
verified

Which term refers to an individual who enrolls in a health plan after the original enrollment date?

Correct Answer
verified

Who may be covered under a GHP?

Correct Answer
verified

Which of the following is a time between the date of an employee's hire and the earliest effective date of insurance coverage?

Correct Answer
verified

Exam 8: Private Payers/BlueCross BlueShield

The health insurance program for federal government employees is

Correct AnswerverifiedShow Answer

A female member of a CDHP has an HSA fund of $820 and a deductible of $500 (which has not yet been met) , and the HDHP has a 75-25 coinsurance. Calculate the amount this patient would owe after drawing down her HSA if the bill for her services is $2,100.

Correct AnswerverifiedShow Answer

How often do open enrollment periods usually occur?

Correct AnswerverifiedShow Answer

Approximately what percentage of all consumers with health insurance are enrolled in a PPO?

Correct AnswerverifiedShow Answer

Which of the following examples demonstrates subcapitation?

Correct AnswerverifiedShow Answer

Which of the following steps comes first in the standard revenue cycle?

Correct AnswerverifiedShow Answer

Which of the following is the most popular type of group health plan?

Correct AnswerverifiedShow Answer

In submitting paper claims, the best practice is to

Correct AnswerverifiedShow Answer

Which type of consumer-driven health plan funding option is set up by individuals rather than employers?

Correct AnswerverifiedShow Answer

Stop-loss provisions protect providers against

Correct AnswerverifiedShow Answer

What might private payers use for a major course of treatment, such as surgery, chemotherapy, and radiation for a patient with cancer?

Correct AnswerverifiedShow Answer

Which term refers to an individual who enrolls in a health plan after the original enrollment date?

Correct AnswerverifiedShow Answer

Who may be covered under a GHP?

Correct AnswerverifiedShow Answer

Which of the following is a time between the date of an employee's hire and the earliest effective date of insurance coverage?

Correct AnswerverifiedShow Answer

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verified

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