RMA Insurance and Reimbursement 1

Question 1

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

Accepted Answer

Medicare

Answer

Medicaid

Answer

CHIP

Answer

TRICARE

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

The total amount a patient pays for insurance premiums each month

Answer

The percentage of costs paid by the insurer after the deductible is met

Answer

The maximum amount a patient must pay out-of-pocket in a year

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 cover prescriptions; PPOs do not

Answer

PPOs are only available through employers; HMOs are government-funded

Answer

HMOs have higher premiums than PPOs

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

The process of combining two insurance cards into one account

Answer

A program that allows patients to transfer benefits between plans

Answer

A billing adjustment made when insurance overpays a provider

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 fixed fee paid each visit regardless of the services received

Answer

The amount the insurer pays before the patient owes anything

Answer

A penalty charged when a patient sees an out-of-network provider

Question 6

A patient's insurance claim is denied due to 'lack of medical necessity.' What does this mean?

Accepted Answer

The insurer determined the service was not clinically justified for the diagnosis

Answer

The patient did not have a valid insurance card at the time of service

Answer

The provider did not submit the claim within the filing deadline

Answer

The patient's deductible has not been met for the year