question

Which statement is correct regarding the insurance industry?

answer

The insurance industry is among the world's largest businesses.

question

Most legal issues of private health insurance claims fall under ______.

answer

civil law

question

When does the physician/patient contract begin?

answer

When the physician accepts the patient and agrees to treat the patient.

question

Most Physician/patient contracts are _____.

answer

implied

question

When a patient carries private medical insurance, the contract for treatment exists between the _______.

answer

physician and the patient

question

An emancipated minor is a person ________.

answer

younger than the age of 18 who lives independently.

question

The contract in a workers' compensation case exists between the ________.

answer

physician and the insurance company

question

In health insurance, the insured is also known as the _____.

answer

Subscriber, member, and policy holder

question

The insured is always the

answer

individual enrollee or organization protected

question

A policy in which the insurer cannot increase premium rates and must renew the policy until the insured reaches the age specified in the contract is a ________ policy.

answer

noncancelable

question

The reason for a coordination of benefits statement in a health insurance policy is to

answer

prevent duplication or overlapping of payments for the same medical expense.

question

Mr. Talili has two medical insurance policies. To prevent duplication of payment for the same medical expense, the policies include a _______ statement.

answer

coordination of benefits

question

In cases of divorce, the decision as to which parent should be responsible for payment of the child's services should be made by the __________.

answer

court system

question

If a child has health insurance coverage from the two parents, according to the birthday law

answer

the health plan of the person whose birthday (month and day) falls earlier in the calendar year will pay first.

question

According to the birthday law, if both the mother and the father have the same birthday, the

answer

plan of the person who has coverage longer is the primary payer.

question

Conditions that existed and were treated before the health insurance policy was issued are called _____.

answer

preexisting

question

An attachment to an insurance policy that excludes certain illnesses or disabilities that would otherwise be covered is referred to as a _______.

answer

waiver

question

What is the correct term used to determine if a procedure is covered and medically necessary?

answer

preauthorization

question

Mrs. Thompett leaves her place of employment, She is eligible to transfer her medical insurance coverage plan from group to an individual contract. This is known as ____ privilege.

answer

conversion

question

Why would conversion from a group policy to an individual policy be advantageous?

answer

No physician examination is required

question

Mr. O was laid off from his job. He is protected under COBRA, which requires his employer to

answer

extend group health insurance coverage for 18 months.

question

What is the minimum number of employees a company must have to meet the criteria of the COBRA for continues medical benefits if an employee is laid off from a company?

answer

20

question

The act created to protect workers and their families so that they can get and maintain health insurance if they change or lose their jobs is called the

answer

HIPAA

question

An organization of physicians, sponsored by a state or local medical association, concerned with the development and deliver of medical services and the cost of health care is known as a

answer

foundation for medical care

question

A type of managed care organization created by the 1982 TEFRA that allows for enrollment of Medicare beneficiaries into managed care plans is a

answer

competitive medical plan. (CMP)

question

A state and federal program for children who are younger than 21 years of age and have special health care needs is

answer

Maternal and Child Health Programs (MCHP)

question

A patient intake sheet is also called a ____.

answer

patient registration form

question

The first document obtained in the initial patient visit is a

answer

patient information form

question

Assignment of benefits is

answer

the transfer of one's legal right to collect the amount payable under an insurance contract.

question

An encounter form may be also known as a

answer

patient service slip

question

The source document for insurance claim data is the

answer

superbill

question

A daily record sheet used to record daily business transactions is called a

answer

day sheet

question

Under HIPAA guidelines, physicians must send all claims electronically if they have _____ full-time employees.

answer

more than 10

question

An insurance claims register facilitates

answer

a follow-up of insurance claims

question

When the physicians services have been submitted to the patient's insurance company by the physician's office, the patient should

answer

be sent a monthly statement indicating the insurance companyy has been billed

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