RMA Insurance and Reimbursement

Question 1

Which federal program provides health insurance primarily to individuals age 65 and older?

Accepted Answer

Medicare

Answer

Medicare is a federal health insurance program that primarily serves people aged 65 and older, as well as certain younger individuals with disabilities or end-stage renal disease.

Question 2

What is a copayment in health insurance?

Accepted Answer

A fixed amount paid by the patient at the time of a healthcare visit

Answer

A copayment (copay) is a fixed, predetermined amount that the patient pays at the time of a medical service, regardless of the total cost of the service.

Question 3

What is the primary difference between HMO and PPO health plans?

Accepted Answer

HMOs require referrals to see specialists; PPOs generally allow direct access

Answer

HMOs (Health Maintenance Organizations) require patients to choose a primary care physician and obtain referrals for specialist care, while PPOs (Preferred Provider Organizations) allow patients to see specialists without referrals.

Question 4

What does 'coordination of benefits' mean when a patient has two insurance plans?

Accepted Answer

Rules that determine which insurance plan pays first when a patient has dual coverage

Answer

Coordination of benefits (COB) is a set of rules that determine the order in which multiple insurance plans pay when a patient is covered by more than one plan, ensuring total payments do not exceed the total charges.

Question 5

Which of the following best describes a deductible in health insurance?

Accepted Answer

The amount a patient must pay out-of-pocket before insurance begins covering costs

Answer

A deductible is the amount a patient must pay for covered health services before their insurance plan begins to pay, typically calculated on an annual basis.

RMA Practice Test

RMA Practice Test

RMA Insurance and Reimbursement