CBCS Health Insurance 2

Question 1

What is a deductible in a health insurance plan?

Accepted Answer

The amount the insured must pay out-of-pocket before the insurance begins paying

Answer

A deductible is the amount a patient must pay for covered services before the insurance company begins sharing costs. Most preventive care services are exempt from deductibles under the ACA.

Question 2

What is the difference between HMO and PPO insurance plans?

Accepted Answer

HMOs require a primary care physician and referrals and limit care to network providers; PPOs allow more flexibility with higher out-of-pocket costs for out-of-network care

Answer

HMOs (Health Maintenance Organizations) coordinate care through a PCP and require referrals to specialists, with coverage limited to the network. PPOs (Preferred Provider Organizations) offer more flexibility, allowing patients to see any provider but with higher costs for out-of-network care.

Question 3

What is Medicare Part B primarily designed to cover?

Accepted Answer

Medical insurance for outpatient services, physician visits, and preventive care

Answer

Medicare Part B is the medical insurance component that covers outpatient services, physician services, preventive care, durable medical equipment, and some home health services.

Question 4

What is the purpose of the Medicare Summary Notice (MSN)?

Accepted Answer

To inform Medicare beneficiaries of claims processed on their behalf, amounts billed, Medicare payment, and patient responsibility

Answer

The Medicare Summary Notice is a statement sent to beneficiaries summarizing claims processed during a given period, including what was billed, what Medicare paid, and what the beneficiary may owe.

Question 5

What does 'prior authorization' (pre-authorization) mean in insurance billing?

Accepted Answer

Advance approval from an insurance company required before certain services can be provided

Answer

Prior authorization is advance approval required by some insurance plans before certain services, medications, or procedures can be performed. Without it, coverage may be denied.

(CBCS) Certified Billing and Coding Specialist Practice Test

(CBCS) Certified Billing and Coding Specialist Practice Test

CBCS Health Insurance 2