1.
One who acts for the insured or the carrier in a claim is called ______________.
Correct Answer
B. Adjuster
Explanation
An adjuster is a person who represents either the insured or the carrier in a claim. They are responsible for investigating and evaluating the claim, determining the coverage and liability, and negotiating settlements. Adjusters play a crucial role in the claims process, ensuring that all parties involved are treated fairly and that the claim is handled appropriately.
2.
A request for payment under an insurance contractor bond is called a(an) _______
Correct Answer
B. Claim
Explanation
A request for payment under an insurance contractor bond is called a claim. This is because when an insured contractor experiences a loss or damage that is covered by the bond, they submit a claim to the insurance company to request payment for the damages. The insurance company then evaluates the claim and if approved, provides the necessary funds to cover the losses incurred.
3.
Payment made periodically to keep an insurance policy in force is called ____________
Correct Answer
B. Premium
Explanation
A payment made periodically to keep an insurance policy in force is called a premium. This is the amount of money that an individual or business pays to an insurance company in exchange for coverage and protection. The premium is typically paid on a monthly, quarterly, or annual basis, depending on the terms of the insurance policy. By paying the premium, the policyholder ensures that their insurance coverage remains active and that they are protected against potential risks and losses.
4.
A person or institution that gives medical care is a(an) ________________
Correct Answer
B. Provider
Explanation
A person or institution that gives medical care is referred to as a "provider". This term encompasses healthcare professionals such as doctors, nurses, hospitals, clinics, and other healthcare facilities that offer medical services to patients. They are responsible for diagnosing and treating illnesses, providing preventive care, and managing patients' overall health.
5.
An amount the insured must pay before policy benefits begin is called ___________
Correct Answer
C. Deductible
Explanation
A deductible is the amount of money that an insured individual must pay out of pocket before their insurance policy benefits begin. It is a common feature in many insurance policies, such as health insurance or auto insurance. The purpose of a deductible is to share the financial burden between the insured individual and the insurance company. By requiring the insured individual to pay a certain amount upfront, it helps to reduce the number of small or frivolous claims and keeps insurance premiums lower for everyone.
6.
An organization that offers insurance against losses in exchange for a premium is called a _________________.
Correct Answer
B. Health maintenance organization
Explanation
A health maintenance organization (HMO) is an organization that provides insurance coverage for losses in exchange for a premium. HMOs typically have a network of healthcare providers that members must use in order to receive coverage. They focus on preventive care and often require members to choose a primary care physician who coordinates their healthcare.
7.
Health insurance that provides protection against the high cost of treating severe or lengthy illnesses or disabilities is called _____________.
Correct Answer
A. CatastropHic
Explanation
Catastrophic health insurance provides coverage for expensive medical treatments related to severe or lengthy illnesses or disabilities. This type of insurance is designed to protect individuals from high healthcare costs that may arise from unexpected medical conditions. It typically has a high deductible and low monthly premiums, making it more affordable for individuals who do not require frequent medical care but want financial protection in case of a major health event.
8.
A patient receiving ambulatory care at a hospital or other health facility without being admitted as a bed patient is called a(an) _____________.
Correct Answer
B. Outpatient
Explanation
An outpatient is a patient who receives medical care at a hospital or health facility without being admitted as a bed patient. They typically visit for consultations, examinations, tests, or minor procedures and do not stay overnight. This term is used to distinguish them from inpatients who require admission and overnight stays for more extensive treatments or surgeries.
9.
An illness or injury that prevents an insured person from performing one or more of the functions of his regular job is called ______________.
Correct Answer
A. Partial disability
Explanation
Partial disability refers to an illness or injury that hinders an insured person from carrying out some, but not all, of the functions of their regular job. This means that the individual is still able to perform certain tasks related to their occupation, but is limited in their ability to perform others. This condition may result in reduced work hours or the need for accommodations, but does not completely prevent the insured person from working.
10.
One who belongs to a group insurance plan is called ______________.
Correct Answer
B. Subscriber
Explanation
A person who is part of a group insurance plan is referred to as a subscriber. This term is commonly used in the insurance industry to identify individuals who are enrolled in a specific insurance policy or plan. The subscriber is usually the primary policyholder or the person responsible for paying the insurance premiums.
11.
A sum of money provided in an insurance policy, payable for covered services is called ______________.
Correct Answer
B. Benefits
Explanation
In an insurance policy, the sum of money provided for covered services is referred to as benefits. This refers to the amount that the policyholder is eligible to receive from the insurance company for the services or expenses covered by the policy. The benefits may include reimbursement for medical expenses, hospitalization costs, prescription drugs, or any other covered services outlined in the policy.
12.
Insurance designed to offset medical expenses resulting from catastrophic or prolonged illness or injury is called ____________.
Correct Answer
B. Major medical
Explanation
Major medical insurance is designed to provide coverage for catastrophic or prolonged illnesses or injuries. It helps offset the high costs of medical expenses that may arise from these situations. Unlike primary insurance, which typically covers routine healthcare expenses, major medical insurance offers more extensive coverage and higher benefit limits. It is often purchased as a supplemental policy to provide additional protection beyond what primary insurance plans offer. Whole life policies, on the other hand, are a type of life insurance that provide coverage for the entire lifetime of the insured individual. Comprehensive insurance refers to a type of coverage that includes a wide range of risks and perils.
13.
An unexpected event which may cause injury is a(n)_________________
Correct Answer
B. Accident
Explanation
An accident is an unexpected event that can cause injury. Unlike the other options, such as a dread disease rider or an adjuster, which are not related to causing injury, an accident is the most appropriate choice for an unexpected event that may result in harm.
14.
A doctor who agrees to accept an insurance companies pre-established fee as the maximum amount to be collected is a(n)_________________
Correct Answer
C. Participating pHysician
Explanation
A doctor who agrees to accept an insurance companies pre-established fee as the maximum amount to be collected is referred to as a participating physician. This means that the doctor has entered into a contract with the insurance company and has agreed to accept their predetermined fee as full payment for services rendered to the insured individual. This arrangement benefits both the doctor and the insured individual, as it helps to control costs and ensures that the insured individual will not be responsible for any additional charges beyond the pre-established fee.
15.
Insurance plans that pay a physician’s full charge if it does not exceed his normal charge or does not exceed the amount normally charged for the service is _________________________.
Correct Answer
A. Usual, customary and reasonable
Explanation
The correct answer is "usual, customary and reasonable". This term refers to insurance plans that will cover the full charge of a physician's service if it falls within the normal range of charges for that service. It ensures that the insurance company will only pay for charges that are considered reasonable and customary within the healthcare industry.
16.
A health program for people age 65 and older under social security is __________.
Correct Answer
B. Medicare
Explanation
Medicare is a health program for people age 65 and older under social security. It provides medical coverage and helps to cover the costs of healthcare services such as hospital stays, doctor visits, and prescription drugs. Tri-Care is a health program for military personnel and their families, Champva is a health program for certain veterans and their dependents, and Worker's Compensation is a program that provides benefits to workers who are injured or become ill on the job.
17.
A civilian health and medical program of the uniform services is ______________.
Correct Answer
A. Tri-Care
Explanation
Tri-Care is a civilian health and medical program of the uniform services. It provides healthcare coverage to active duty service members, their families, retired service members, and their families. Tri-Care offers a range of healthcare options, including health plans, prescriptions, and dental coverage. It is designed to ensure that military personnel and their families receive comprehensive and affordable healthcare services.
18.
A form of insurance paid by the employer providing cash benefits to workers injured or disabled in the course of employment is ____________________.
Correct Answer
C. Worker’s Compensation
Explanation
Worker's Compensation is a form of insurance paid by the employer to provide cash benefits to workers who are injured or disabled while on the job. It is designed to cover medical expenses, lost wages, and rehabilitation services for employees who suffer work-related injuries or illnesses. This insurance helps to protect both the employer and the employee by providing financial support and ensuring that the injured worker receives the necessary care and support to recover and return to work.
19.
A recap sheet that accompanies a Medicare or Medicaid check, showing breakdown and explanation of payment on a claim is a(n) _______________.
Correct Answer
B. Explanation of benefits
Explanation
A recap sheet that accompanies a Medicare or Medicaid check, showing breakdown and explanation of payment on a claim is referred to as an "explanation of benefits." This document provides a detailed summary of the services rendered, the amount billed, the amount covered by insurance, and any remaining balance that may be the responsibility of the patient. It helps individuals understand how their insurance coverage is being utilized and provides transparency regarding the payment process.
20.
A type of insurance whereby the insured pays a specific amount per unit of service and the insurer pays the rest of the cost is a(n) ______________________.
Correct Answer
A. Co-payment
Explanation
A co-payment is a type of insurance where the insured pays a specific amount per unit of service, such as a doctor's visit or prescription, and the insurer covers the remaining cost. It is a cost-sharing arrangement between the insured and the insurer, where the insured is responsible for a fixed amount of the total cost. This helps to reduce the financial burden on the insured while still ensuring that they contribute towards their healthcare expenses.
21.
In insurance, greater coverage of diseases or an accident, and greater indemnity payment in comparison with a limited clause is a(n) ___________________.
Correct Answer
B. Comprehensive
Explanation
Comprehensive insurance provides greater coverage for diseases or accidents compared to a limited clause. It offers a wider range of benefits and protections, including higher indemnity payments. This type of insurance is more comprehensive in its coverage, making it a suitable option for individuals seeking extensive protection.
22.
An interval after a payment is due to the insurance company in which the policy holder may make payments, and still the policy remains in effect is a(n) ____________.
Correct Answer
B. Grace period
Explanation
A grace period is a specific time period after a payment is due to the insurance company in which the policy holder is allowed to make payments without any penalty or loss of coverage. During this time, the policy remains in effect, providing the policy holder with continued insurance coverage despite the late payment. This allows the policy holder some flexibility in making payments without immediately losing their insurance benefits.
23.
An agreement by which a patient assigns to another party the right to receive payment from a third party for the services the patient has received is a(n) __________________.
Correct Answer
A. Assignment
Explanation
An agreement by which a patient assigns to another party the right to receive payment from a third party for the services the patient has received is referred to as an "assignment". This means that the patient authorizes someone else to receive the payment on their behalf. It is a common practice in healthcare when patients want their insurance provider to pay the healthcare provider directly.
24.
A skilled nursing facility for patients receiving specialized care after discharge from a hospital is a(n) ____________________.
Correct Answer
A. Extended care facility
Explanation
An extended care facility is a type of healthcare facility that provides specialized care to patients who have been discharged from a hospital. This type of facility is specifically designed to meet the needs of patients who require ongoing medical attention and rehabilitation after leaving the hospital. It offers a higher level of care compared to a nursing home or post care facility, making it the correct answer in this context.
25.
Payment for hospital charges incurred by an insured person because of injury or illness is a(n) ___________________.
Correct Answer
A. Hospital benefits
Explanation
Payment for hospital charges incurred by an insured person because of injury or illness is referred to as hospital benefits. This term is used to describe the financial coverage provided by an insurance policy specifically for hospital-related expenses. It includes costs such as room and board, surgeries, medications, and other necessary medical treatments received during a hospital stay. Hospital benefits ensure that the insured person does not have to bear the entire financial burden of their medical care and can receive the necessary treatment without worrying about the costs involved.
26.
A agent of an insurance company who solicits or initiates contracts of insurance and services the policyholder for the insurer is a(n) _____________________.
Correct Answer
A. Insurance agent
Explanation
An insurance agent is a representative of an insurance company who is responsible for soliciting and initiating contracts of insurance. They also provide services to policyholders on behalf of the insurer.
27.
A method of charging whereby a physician presents a bill for each service rendered is a(n) ___________________.
Correct Answer
B. Fee-for-service
Explanation
A method of charging whereby a physician presents a bill for each service rendered is referred to as fee-for-service. This means that the physician charges for each individual service provided to the patient, rather than bundling them together or billing a flat fee. This allows for transparency in pricing and ensures that patients are only charged for the specific services they receive.
28.
The Tri-Care fiscal begins __________ and ends ___________.
Correct Answer
C. October 1 to September 30
Explanation
The Tri-Care fiscal year begins on October 1st and ends on September 30th.
29.
The Employees Withholding Exemption Certificate form number is also known as a ___________ form.
Correct Answer
B. W-4
Explanation
The Employees Withholding Exemption Certificate form number is also known as a W-4 form. This form is used by employees to inform their employers about the amount of federal income tax to withhold from their paycheck. It includes information such as the employee's filing status, number of allowances, and any additional withholding amounts. This form helps ensure that the correct amount of taxes is withheld from the employee's wages throughout the year.
30.
FICA provides benefits are for ____________________.
Correct Answer
B. Social security
Explanation
FICA provides benefits for social security. The Federal Insurance Contributions Act (FICA) is a United States law that requires employees to contribute a portion of their earnings to fund social security and Medicare. Social security benefits are provided to retired workers, disabled individuals, and their dependents. These benefits include retirement income, disability benefits, survivor benefits, and healthcare coverage through Medicare. FICA deductions from an employee's paycheck go towards funding these social security benefits.
31.
The physician’s bank statement is reconciled with a __________________.
Correct Answer
D. Checkbook
Explanation
The physician's bank statement is reconciled with a checkbook. This means that the physician compares the transactions recorded in their bank statement with the transactions recorded in their checkbook to ensure that they match. By doing this, the physician can verify the accuracy of their bank statement and identify any discrepancies or errors.
32.
Amounts purchased on credit and owed to creditors are also known as ____________.
Correct Answer
C. Accounts payable
Explanation
Amounts purchased on credit and owed to creditors are known as accounts payable. This refers to the money that a company owes to its suppliers or vendors for goods or services that have been purchased on credit. It represents the company's short-term liabilities and is recorded as a current liability on the balance sheet. Accounts payable is an important aspect of a company's financial management as it represents the company's obligations to pay its debts in a timely manner.
33.
Cash, furniture, and equipment are also known as _______________.
Correct Answer
C. Assets
Explanation
Cash, furniture, and equipment are considered assets because they have economic value and can be used to generate future benefits for the company. Liabilities refer to the company's debts or obligations, while depreciable assets specifically refer to assets that lose value over time due to wear and tear. Mutually owned property does not accurately describe cash, furniture, and equipment as it implies joint ownership by multiple parties. Therefore, the correct answer is assets.
34.
Patient accounts having a zero balance are known as __________________.
Correct Answer
C. Closed accounts
Explanation
Closed accounts refer to patient accounts that have a zero balance. This means that all outstanding payments have been made and there are no more financial obligations between the patient and the healthcare provider. These accounts are considered closed because there is no further action required from the patient or the provider in terms of payment or billing.
35.
An instrument reflecting the details of sales or purchase transaction is a(n) _____________.
Correct Answer
A. Invoice
Explanation
An invoice is a document that reflects the details of a sales or purchase transaction. It typically includes information such as the date, description, quantity, and price of the goods or services being bought or sold. It serves as a record of the transaction and is often used for accounting and payment purposes. A ledger card is a record of individual accounts, a disbursement record is a record of payments made, and a payment record is a record of specific payments. However, none of these options specifically reflect the details of sales or purchase transactions like an invoice does.
36.
An employee must obtain a Social Security Number which is assigned by the ________________.
Correct Answer
D. Federal Government
Explanation
An employee must obtain a Social Security Number which is assigned by the Federal Government. The Social Security Number is a unique identifier that is used for various purposes, such as tracking an individual's earnings and contributions to the Social Security program. It is issued by the Social Security Administration, which is a federal agency responsible for administering social security programs in the United States.
37.
The physician is required to give his/her employees a W-2 form on or before __________.
Correct Answer
D. February 1st
Explanation
The physician is required to give his/her employees a W-2 form on or before February 1st. This is the deadline set by the Internal Revenue Service (IRS) for employers to provide their employees with their W-2 forms, which report their annual wages and taxes withheld. Providing the W-2 forms by this date ensures that employees have enough time to file their tax returns before the April 15th deadline.
38.
A system whereby large quantities of data can be accessed, searched, sorted, and arranged very rapidly by computer is also known as a(n) __________________.
Correct Answer
D. Data base management
Explanation
A system whereby large quantities of data can be accessed, searched, sorted, and arranged very rapidly by computer is also known as data base management.
39.
The computer, printer, disk drives, and monitors are also known as ____________.
Correct Answer
B. Hardware
Explanation
The computer, printer, disk drives, and monitors are collectively referred to as hardware. Hardware refers to the physical components of a computer system that can be seen and touched. These devices are essential for the functioning of a computer system and enable users to perform various tasks such as processing data, printing documents, and displaying visual information.
40.
Programs which tell the computer what to do are also known as ______________.
Correct Answer
B. Software
Explanation
Programs are a set of instructions that tell the computer what to do. These instructions are stored in software, which is a collection of programs, data, and instructions that are used to operate computers and perform specific tasks. Therefore, software is the correct answer as it accurately describes the programs that tell the computer what to do.
41.
Using the computers DEL command is also known as ______________.
Correct Answer
B. Delete
Explanation
Using the computer's DEL command refers to the action of deleting files or directories. The DEL command is a command prompt command that allows users to remove files and folders from their computer's storage. It is commonly used to permanently delete unwanted files and clean up disk space.
42.
The computers directional arrow keys are known to ________________.
Correct Answer
C. Move the cursor, right, left, up or down
Explanation
The computers directional arrow keys are known to move the cursor, right, left, up or down. These keys are commonly used to navigate through documents, web pages, and other interfaces. By pressing the arrow keys, the user can move the cursor in the desired direction without having to use the mouse. This allows for quick and precise movement within a document or program.
43.
Referring to computers, the term “user friendly” means ______________.
Correct Answer
D. How easy the system is to operate
Explanation
The term "user friendly" in the context of computers refers to how easy the system is to operate. It implies that the system has a user interface and features that are intuitive and straightforward, allowing users to navigate and interact with the system without difficulty. This term does not directly relate to the quality of the manual, the system's capacity to handle documents, or its cost-effectiveness.
44.
A fraudulent signature is known as a(n) __________________.
Correct Answer
B. Forgery
Explanation
A fraudulent signature refers to the act of creating or using a fake signature with the intent to deceive or defraud others. This is commonly known as forgery, where someone imitates or replicates another person's signature without their consent or knowledge. The purpose of forgery can vary, but it usually involves illegal activities such as identity theft, financial fraud, or falsifying legal documents.
45.
In banking a deposit or addition to a bank account is also known as a(n) ________.
Correct Answer
B. Credit
Explanation
A deposit or addition to a bank account is commonly referred to as a credit. This term is used because it represents an increase in the balance or available funds in the account. When money is credited to an account, it indicates that the account holder is receiving funds, either through a deposit or another type of transaction.
46.
A signature on the reverse side of a check is also known as a(n) ______________.
Correct Answer
B. Endorsement
Explanation
A signature on the reverse side of a check is known as an endorsement. This is when the payee signs the back of the check, indicating that they are transferring the rights to the funds to another party. Endorsements can be blank, restrictive, or special, depending on the instructions provided by the payee.
47.
To correct a handwritten error in a patient’s chart, the only acceptance is _______.
Correct Answer
D. Draw a line through the error, insert the correct information, date and initial it
Explanation
To correct a handwritten error in a patient's chart, the accepted method is to draw a line through the error, insert the correct information, date it, and initial it. This method ensures that the original error is still visible, while clearly indicating the correction that has been made. It also provides a clear record of when and by whom the correction was made, which is important for maintaining the integrity and accuracy of the patient's chart.
48.
The insurance program that covers needy and low income people is known as __________.
Correct Answer
A. Medicaid
Explanation
Medicaid is a government insurance program that provides coverage for low-income individuals and families who cannot afford private health insurance. It is specifically designed to assist those who have limited income and resources, ensuring that they have access to necessary medical services and treatments. Medicaid is different from Medicare, which primarily caters to individuals aged 65 and older, as well as those with certain disabilities. Tri-Care and Blue Cross/Blue Shield are private insurance programs that may have different eligibility criteria and coverage options.
49.
The American Medical Association developed a reference procedural code book using a numerical system for procedures known as a(n) ________________.
Correct Answer
B. Current procedural terminology
Explanation
The American Medical Association developed a reference procedural code book using a numerical system for procedures known as current procedural terminology. This system helps healthcare providers accurately communicate medical procedures and services to insurance companies for billing and reimbursement purposes. It is widely used in the healthcare industry to ensure consistency and accuracy in coding and billing practices.
50.
The proper procedure for canceling an appointment in the appointment book is ______________.
Correct Answer
D. Mark through the entry with a single red line
Explanation
The proper procedure for canceling an appointment in the appointment book is to mark through the entry with a single red line. This ensures that the entry is clearly crossed out and easily noticeable, indicating that the appointment has been canceled. Using a single red line helps to distinguish the cancellation from other markings or annotations in the appointment book.