Office Medical Terminology Pt1

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  • 1/10 Questions

    A type of cost sharing where the beneficiary and insurance provider share payment of the approved charge for covered services in a specidied ratio after payment of the deductible by the insured. For example, the insurance company agrees to pay 80% of covered charges and the individual picks up 20%.

    • Deductible
    • Co-insurance
    • Monthly Premiums
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About This Quiz

This quizz is designed to help with medical terminology that will help you when you are dealing with insurance companies trying to get claims paid.

Office Medical Terminology Pt1 - Quiz

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  • 2. 

    Part A Beneficiaries are responsible for

    • Monthly premiums, co-payments, deductibles and balance billing.

    • Deductibles and co-pays

    Correct Answer
    A. Deductibles and co-pays
    Explanation
    Beneficiaries are responsible for deductibles and co-pays. Deductibles are the amount of money that beneficiaries must pay out of pocket before their insurance coverage begins. Co-pays, on the other hand, are fixed amounts that beneficiaries must pay for each healthcare service or prescription medication. These costs are separate from monthly premiums, which beneficiaries also have to pay. Therefore, beneficiaries are responsible for deductibles and co-pays in addition to monthly premiums, but not for balance billing, which refers to the amount that healthcare providers charge above what insurance covers.

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  • 3. 

    A set fee the member pays to providers at the time services are provided. applied to emergency room visits, hospital admissions, office visits, etc. The cost is usually minimal. The patient should be aware of this amount prior to services being rendered.

    • Co-insurance

    • Deductible

    • Co-payment

    Correct Answer
    A. Co-payment
    Explanation
    A co-payment is a set fee that a member pays to providers at the time services are provided. It is usually applied to emergency room visits, hospital admissions, office visits, and other medical services. The cost of a co-payment is typically minimal and the patient should be aware of this amount before receiving any services.

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  • 4. 

    Part B Medicare covers patients for

    • Physician services, medical supplies and other outpatient treatments

    • Inpatient hospital, home health, hospice and limited skilled nursing facility services.

    • Inpatient and limited skilled nursing facility services.

    • Physician services and home health care

    Correct Answer
    A. Physician services, medical supplies and other outpatient treatments
    Explanation
    Part B Medicare covers patients for physician services, medical supplies, and other outpatient treatments. This means that individuals who have Part B Medicare will have coverage for visits to doctors, specialists, and other healthcare providers, as well as for necessary medical supplies and treatments that are received outside of a hospital setting. This coverage is important for individuals who require ongoing medical care or who need regular access to healthcare services and supplies.

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  • 5. 

    Coverage for treatment obtained from a non-participating provider. Typically, it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider. Insurer may also deny entire bill.

    • Out of Pocket Costs (OOPs)

    • Out of Network (OON)

    • Pre-Admission Certification (PAC)

    Correct Answer
    A. Out of Network (OON)
    Explanation
    Out of Network (OON) refers to coverage for treatment obtained from a non-participating provider. This means that the healthcare provider is not contracted with the insurer, resulting in higher out of pocket costs for the insured individual. OON coverage typically requires payment of a deductible and higher co-payments and co-insurance compared to treatment from a participating provider. Additionally, the insurer may choose to deny the entire bill for services received from an out of network provider.

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  • 6. 

    The Birthday Rule states that.......

    • Parent whos birthday is closest day of the child

    • Parent whose date of birth (year and month) is earlier is the primary plan for dependent.

    • Parent whose date of birth (month and day) falls earlier in the calendar year is the primary plan for dependent.

    Correct Answer
    A. Parent whose date of birth (month and day) falls earlier in the calendar year is the primary plan for dependent.
    Explanation
    The Birthday Rule states that the parent whose date of birth (month and day) falls earlier in the calendar year is the primary plan for the dependent. This means that if both parents have different birthdates, the parent whose birthday occurs earlier in the year will be considered the primary plan for the dependent. This rule helps determine which parent's insurance plan will be the primary one for covering the dependent's medical expenses.

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  • 7. 

    A portion of the covered expenses (typically $100, $200 or $500) that an insured individual must pay before insurance coverage with co-insurance goes into effect. They are usually standard in many policies, and are usually based on a calendar year.

    • Co-insurance

    • Monthly Premiums

    • Deductible

    Correct Answer
    A. Deductible
    Explanation
    A deductible is a portion of the covered expenses that an insured individual must pay before insurance coverage with co-insurance goes into effect. It is a standard feature in many insurance policies and is typically based on a calendar year. The deductible amount can vary, but it is usually set at $100, $200, or $500. This means that the insured individual is responsible for paying this amount out of pocket before the insurance coverage kicks in.

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  • 8. 

    Part B Medicare Beneficiaries are responsible for

    • Deductibles and co-pays

    • Monthly premiums, co-payments, deductibles and balance billing.

    Correct Answer
    A. Monthly premiums, co-payments, deductibles and balance billing.
    Explanation
    Medicare Part B is a health insurance program in the United States that covers medical services such as doctor visits, outpatient care, and preventive services. Beneficiaries are responsible for paying certain costs, including monthly premiums, co-payments, deductibles, and balance billing. This means that they have to contribute a monthly payment towards their coverage, pay a portion of the cost of each medical service they receive, cover a certain amount of expenses out of pocket before Medicare starts paying, and potentially pay the difference between what the provider charges and what Medicare approves for payment.

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  • 9. 

    Part A Medicare covers patients for

    • Inpatient and limited skilled nursing facility services.

    • Inpatient hospital, home health, hospice, and limited skilled nursing facility services.

    • Physician sevices, medical supplies, and other outpatient treatment.

    • Physician services and home health care

    Correct Answer
    A. Inpatient hospital, home health, hospice, and limited skilled nursing facility services.
    Explanation
    Medicare is a healthcare program in the United States that provides coverage for certain medical services for eligible individuals. The correct answer states that Medicare covers inpatient hospital services, home health services, hospice care, and limited skilled nursing facility services. This means that Medicare will pay for hospital stays, medical care at home, end-of-life care, and a certain level of care in a skilled nursing facility. This coverage is important for individuals who require these types of services and helps to ensure that they have access to necessary medical care.

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  • 10. 

    Medicaid is (pick two anwers)

    • A jointly-funded, federal and state health insurance program

    • A federal funded health insurance program

    • A state health insurance program

    • Only for people under 65, low income, and/or disabled.

    • For certain low-income and needy people including children, the aged, blind, and/or disabled, and people who are eligible to receive federally assisted income maintenance payments

    Correct Answer(s)
    A. A jointly-funded, federal and state health insurance program
    A. For certain low-income and needy people including children, the aged, blind, and/or disabled, and people who are eligible to receive federally assisted income maintenance payments
    Explanation
    Medicaid is a health insurance program that is funded by both the federal government and individual states. It provides coverage for certain low-income and needy individuals, including children, the elderly, the blind, the disabled, and those who are eligible for federally assisted income maintenance payments.

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  • Current Version
  • Mar 21, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Feb 25, 2009
    Quiz Created by
    Aholmes
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