Medical Insurance Practice

Insurance Practice Questions

Taking a medical assistant test like the RMA or CMA? Medical insurance practice test questions similar to the RMA and CMA

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Practice Questions

1. What type of Medical Insurance plan does the employer typically pay?

a. Health Maintenance Organization (HMO)
b. Indemnity
c. Major Medical
d. None of the Above

2. Preferred Provider Organization (PPO) insurance:

a. is a list of health care providers that provided services
at a discounted rate.
b. does not cover primary care.
c.
 usually has deductibles and limits.
d. does not offer a discounted rate.

3. Which program offers health care to dependents and spouses of service women and men?

a. Medigap
b. Tricare
c. Commercial Insurance
d. CHAMPVA

4. What Medical plan is for people over 65?

a. Medicaid
b. Tricare
c. CHAMPVA
d. Medicare

5. What is an RVU?

a. the system for reimbursement.
b. a component that is multiplied by a monetary conversion
factor to calculate physicians costs.
c.
 a list of procedures.
d. a list of procedures and their cost.

 

Answer Key

1. A
Health Maintenance Organizations, or HMOs, are organizations that are created with the intention of managing insurance contracts by working as a middle man between the insurance provider and the health care professionals, whether they be doctors, hospitals, or other professionals. Employers who have 25 employees or more are required, if they also offer traditional options for healthcare, to offer an HMO option that has been federally certified under the Health Maintenance Organization Act of 1973. This is different from traditional indemnity insurance in that it only protects care that is provided by professionals, such as doctors, who have an agreement to treat patients in a way that meets the HMO guidelines in exchange for a stream of steady patients.

2. A
In the United States, a PPO, or preferred provider organization, is an organization of hospitals, doctors, and other professional providers who have reached an agreement with third-party groups, such as insurers, to provide reduced rate care to the third-party’s clients.  This is a subscription-based arrangement between the preferred provider and the insurance group. This kind of membership provides a substantial saving that is well below the rates that are normally charged by the health care organization.

In return, Preferred Provider Organizations also earn revenue by charging the insurer for access to their network of healthcare providers. These rates are negotiated with providers to arrange schedules of fees  as well as manage any dispute that takes place between the provider and insurer.

3. B
The health care program used in the United States Department of Defence Military Health System is known as TRI CARE, although it was previously referred to as CHAMPUS, or the Civilian Health and Medical Program of the Uniformed Services. This service provides military retirees, personnel, their dependents, and members of the Military Reserve with civilian healthcare benefits.

4. D
The United States Government administers a social insurance program known as Medicare, which works to provide citizens 65 years of age and over with health insurance coverage. It also provides that coverage to citizens who are below the age of 65, but are disabled physically, have a congenital physical disability, or who meet a special set of
criteria.

The Medicare reimbursement formula used by physicians is measured in Relative Value Units, or RVUs. These units are components of the resource-based relative value scale, or
RBRVS.

Written by,

Date Published: Tuesday, April 22nd, 2014
Date Modified: Sunday, August 22nd, 2021

    1 Comment

  1. Loene Loan
    January 14, 2016
    Reply

    thank u for more help on test

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