Introduction to Health Services
Test Bank
Course Introduction
Introduction to Health Services provides an overview of the organization, delivery, and financing of health care systems with a primary focus on the United States. Students will explore the historical development of health services, major stakeholders, and the various settings where care is provided, including hospitals, ambulatory centers, long-term care facilities, and public health organizations. The course examines key topics such as healthcare policy, quality improvement, access to care, workforce challenges, and the role of technology in health services. Emphasis is placed on understanding the complex interactions between patients, providers, insurers, and government agencies, as well as current issues and future directions in health services.
Recommended Textbook Health Insurance Today A Practical Approach 5th Edition by Janet I. Beik AA BA Med
Available Study Resources on Quizplus
18 Chapters
1335 Verified Questions
1335 Flashcards
Source URL: https://quizplus.com/study-set/638
Page 2
Chapter 1: The Origins of Health Insurance
Available Study Resources on Quizplus for this Chatper
45 Verified Questions
45 Flashcards
Source URL: https://quizplus.com/quiz/12084
Sample Questions
Q1) One of the new healthcare laws enacted in 2010 that brought major changes to how Americans can get access to healthcare more easily is the:
A) Health Insurance Portability and Accountability Act (HIPAA).
B) Health Maintenance Organization (HMO) Act.
C) Patient Protection and Affordable Care Act (PPACA).
D) Consolidated Omnibus Budget Reconciliation Act (COBRA).
Answer: C
Q2) The combined federal and state healthcare program for indigent and low-income individuals is:
A) Medicare.
B) Medicaid.
C) Blue Cross.
D) health maintenance.
Answer: B
Q3) Health insurance narrows down undesirable events to:
A) illnesses and injuries.
B) automobile accidents.
C) preventive illnesses.
D) preexisting conditions.
Answer: A
To view all questions and flashcards with answers, click on the resource link above. Page 3
Chapter 2: Tools of the Trade: A Career as a Health (Medical)Insurance
Professional
Available Study Resources on Quizplus for this Chatper
40 Verified Questions
40 Flashcards
Source URL: https://quizplus.com/quiz/12085
Sample Questions
Q1) When a covered entity can clearly demonstrate the ability to successfully create and receive compliant transactions using the new 5010 version,it is said to have:
A) preliminary endorsement.
B) appropriate acquisition.
C) Level I compliance.
D) compatibility.
Answer: C
Q2) Organizing daily responsibilities according to their importance is called:
A) colonizing.
B) multitasking.
C) prioritizing.
D) categorizing.
Answer: C
Q3) Computers have dramatically changed the face of health insurance.
A)True
B)False
Answer: True
To view all questions and flashcards with answers, click on the resource link above.
Page 4
Chapter 3: The Legal and Ethical Side of Medical Insurance
Available Study Resources on Quizplus for this Chatper
67 Verified Questions
67 Flashcards
Source URL: https://quizplus.com/quiz/12086
Sample Questions
Q1) When an individual has the legal ability to handle another person's affairs,he or she is said to have ____________________.
Answer: power of attorney
Q2) A clinical,scientific,administrative,and legal document of facts containing statements relating to a patient is a definition of a:
A) compliance plan.
B) HIPAA standard.
C) medical record.
D) retention statute.
Answer: C
Q3) An authorization to release information should contain all of the following,except the: A) patient's name.
B) primary diagnosis.
C) patient's signature.
D) description of the information to be released.
Answer: B
Q4) Legal form is only applicable in __________ contracts.
Answer: written
To view all questions and flashcards with answers, click on the resource link above. Page 5
Chapter 4: Types and Sources of Health Insurance
Available Study Resources on Quizplus for this Chatper
48 Verified Questions
48 Flashcards
Source URL: https://quizplus.com/quiz/12087
Sample Questions
Q1) Under COBRA,employees working for qualifying employers can continue their healthcare coverage indefinitely when they leave or lose their job.
A)True
B)False
Q2) After the yearly deductible is met,the patient typically shares the bill with the insurance company in an arrangement called ____________________.
Q3) A provider who is under no contractual agreement with the insurer to accept reimbursement as payment in full.
Q4) A special tax shelter set up for the purpose of paying medical bills.
Q5) The Affordable Care Act now makes it illegal for health insurance companies to deny coverage to any applicant with a preexisting condition.
A)True
B)False
Q6) SSDI is an insurance program that only individuals older than 65 can qualify for. A)True
B)False
Q7) The flexible spending account (FSA)is an IRS Section 125 _____________.
To view all questions and flashcards with answers, click on the resource link above. Page 6
Chapter 5: Claim Submission Methods
Available Study Resources on Quizplus for this Chatper
70 Verified Questions
70 Flashcards
Source URL: https://quizplus.com/quiz/12088
Sample Questions
Q1) The most common format used for computer text files and on the Internet is:
A) OCR.
B) JAVA.
C) ASCII.
D) HTML.
Q2) Guidelines for claim attachments are the same if the medical facility uses electronic claim submission.
A)True
B)False
Q3) Submitting insurance claims straight to a third-party payer is called:
A) editing.
B) direct claims submission.
C) clearinghouse/direct.
D) none of these; providers cannot submit claims directly to third-party payers.
Q4) Name the two entities that have the responsibility of updating and revising the CMS-1500 universal form?
Q5) One way to track submitted claims is through the use of an insurance claims tracking form or "log."
A)True
B)False
To view all questions and flashcards with answers, click on the resource link above. Page 7
Chapter 6: Traditional Fee For Service/Private Plans
Available Study Resources on Quizplus for this Chatper
74 Verified Questions
74 Flashcards
Source URL: https://quizplus.com/quiz/12089
Sample Questions
Q1) Blue Cross and Blue Shield organizations are governed at the national level.
A)True
B)False
Q2) Under the Affordable Care Act,no annual dollar limits are allowed on most covered benefits beginning January 1,2014.
A)True
B)False
Q3) Name the type of managed care plan that combines characteristics of both the HMO and the PPO.
Q4) Commercial carriers must furnish their own specific insurance claim form and cannot use the CMS-1500.
A)True
B)False
Q5) An organization that determines payment for Part B-covered items and provider services is now more commonly called a ______________________.
Q6) In addition to the premium,an out-of-pocket amount that usually must be paid before insurance payments begin is called the ___________.
Q7) Name the two basic categories of health insurance.
Page 8
To view all questions and flashcards with answers, click on the resource link above.
Chapter 7: Unraveling the Mysteries of Managed Care
Available Study Resources on Quizplus for this Chatper
50 Verified Questions
50 Flashcards
Source URL: https://quizplus.com/quiz/12090
Sample Questions
Q1) Which federal act,passed in 1996,is intended to improve the efficiency of healthcare delivery,reduce administrative cost,and protect patient privacy?
A) HCFA
B) HIPAA
C) EMTLA
D) COBRA
Q2) A process used by health insurance companies to control healthcare costs,similar to preauthorization,is ____________________.
Q3) A group of healthcare providers working under one umbrella to provide medical services at a discount to the individuals who participate in the plan is referred to as a/an:
A) HMO.
B) FFS.
C) AMA.
D) PPO.
Q4) Managed care has had little impact on healthcare in general in the United States.
A)True
B)False
To view all questions and flashcards with answers, click on the resource link above. Page 9
Chapter 8: Understanding Medicaid
Available Study Resources on Quizplus for this Chatper
87 Verified Questions
87 Flashcards
Source URL: https://quizplus.com/quiz/12091
Sample Questions
Q1) There is a Medicaid program in all 50 states,the District of Columbia,and U.S.territories.
A)True
B)False
Q2) Facilities that receive additional payments to ensure that communities have access to certain high-cost services such as trauma and emergency care and burn services are called ______________.
Q3) The ____________ program provides comprehensive alternative care for non-institutionalized elderly who otherwise would be in a nursing home.
Q4) The legal obligation of other insuring entities to pay all or part of the healthcare expenses of a Medicaid beneficiary is called:
A) pay or chase.
B) third-party liability.
C) payer of last resort.
D) reciprocity.
Q5) Write a brief summary of the development and structure of Medicaid
Q6) _____________ is where the healthcare provider bills and collects from liable third parties before sending the claim to Medicaid.
To view all questions and flashcards with answers, click on the resource link above. Page 10
Chapter 9: Conquering Medicares Challenges
Available Study Resources on Quizplus for this Chatper
105 Verified Questions
105 Flashcards
Source URL: https://quizplus.com/quiz/12092
Sample Questions
Q1) Medicare Part C was previously called ___________;it was renamed by The Medicare Prescription,Improvement,and Modernization Act of 2003 (MMA)and is now called ___________.
Q2) Beneficiaries enrolled in the "original" Medicare plan must pay a yearly deductible.
A)True
B)False
Q3) Unlike original Medicare,Medicare managed care plans often pay for what items?
Q4) The HMO is the most expensive and least restrictive type of Medicare managed care plan.
A)True
B)False
Q5) Medicare's fee schedule is based on a system whereby each payment value is found within a range of payments known as:
A) OPPS.
B) RBRVS.
C) fee-for-service.
D) usual, customary, and reasonable.
Q6) List the five levels of the Medicare appeal request process.
Q7) Define a remittance advice,and describe the information it contains.
Page 11
To view all questions and flashcards with answers, click on the resource link above.
Chapter 10: Military Carriers
Available Study Resources on Quizplus for this Chatper
80 Verified Questions
80 Flashcards
Source URL: https://quizplus.com/quiz/12093
Sample Questions
Q1) TRICARE Plus is available only to those enrolled in a TRICARE Prime option,a civilian HMO,or Medicare HMO.
A)True
B)False
Q2) What is a nonavailability statement (NAS)?
Q3) The responsibilities of a TRICARE regional contractor include all of the following,except:
A) establishing provider networks.
B) operating TRICARE service centers.
C) overseeing conduct on military bases.
D) providing healthcare services and support.
Q4) OHI does not include TRICARE supplemental insurance or Medicaid. A)True B)False
Q5) An ID card alone is not always sufficient to prove current TRICARE eligibility. A)True B)False
Q6) Individuals who are eligible for CHAMPVA benefits are not TRICARE eligible. A)True B)False
Page 12
To view all questions and flashcards with answers, click on the resource link above.
Chapter 11: Miscellaneous Carriers: Workers Compensation and Disability Insurance
Available Study Resources on Quizplus for this Chatper
55 Verified Questions
55 Flashcards
Source URL: https://quizplus.com/quiz/12094
Sample Questions
Q1) Workers' compensation insurance is considered to be "no-fault insurance," which means
A) benefits are paid regardless of who is to blame for the injury.
B) benefits are not paid because it is considered nobody's fault.
C) if it is unclear whose fault the injury is, workers' compensation does not have to pay.
D) the employee and employer share medical expenses.
Q2) Workers' compensation insurance is no-fault insurance.Explain what this means.
Q3) In which era did workers' compensation get its start?
A) 1700s
B) 1800s
C) 1900s
D) 2000s
Q4) Workers' compensation is considered no-fault,and benefits are paid regardless of who is to blame for the injury.
A)True
B)False
Q5) Workers' compensation benefits are not paid for certain work-related incidents when injury occurs as a result of certain irresponsible actions by the employee.Name four of these.
To view all questions and flashcards with answers, click on the resource link above. Page 13
Chapter 12: Diagnostic Coding
Available Study Resources on Quizplus for this Chatper
132 Verified Questions
132 Flashcards
Source URL: https://quizplus.com/quiz/12095
Sample Questions
Q1) Parentheses in the Alphabetic Index have no special meaning.
A)True
B)False
Q2) All of the following are contained in Part II of the Alphabetic Index (Vol.2)except the A) Table of Neoplasms
B) Table of Drugs and Chemicals
C) External Cause Index
D) Tabular List of Diseases and Injuries
Q3) Diagnosis is the determination of the nature of a cause of disease.
A)True
B)False
Q4) The abbreviation ICD-10-CM stands for ____________________.
Q5) Coding involves transforming verbal descriptions of a diagnosis into numbers or a combination of alphanumeric characters.
A)True
B)False
Q6) In ICD-9,Volume 2 (Alphabetic List)is organized _____________ by medical terms and contains three separate sections or indexes.
To view all questions and flashcards with answers, click on the resource link above. Page 14
Chapter 13: Procedural, Evaluation and Management, and
HCPCS Coding
Available Study Resources on Quizplus for this Chatper
122 Verified Questions
122 Flashcards
Source URL: https://quizplus.com/quiz/12096
Sample Questions
Q1) A CPT code can be displayed one of three ways: as ____________,____________,or ______________.
Q2) The AMA developed and published the first CPT manual in 1966.
A)True
B)False
Q3) The E/M codes are found at the end of the CPT manual.
A)True
B)False
Q4) The level of _____________ is determined by the complexity involved in the healthcare provider's assessment of and professional judgment regarding the patient's diagnosis and care.
A) UCR schedule fees
B) medical decision making
C) the patient's status
D) the patient's examination
Q5) What are the two major subcategories of nursing facilities?
A) Initial/subsequent
B) Inpatient/outpatient
C) Critical/observation
D) Emergency/nonemergency
To view all questions and flashcards with answers, click on the resource link above. Page 15
Chapter 14: The Patient
Available Study Resources on Quizplus for this Chatper
74 Verified Questions
74 Flashcards
Source URL: https://quizplus.com/quiz/12097
Sample Questions
Q1) No matter how experienced and persuasive the health insurance professional or collection manager is,there always will be some bad debts in a healthcare practice.
A)True
B)False
Q2) Before a small claims lawsuit can proceed,the court expects the _____ to have explored all other avenues of settlement.
A) plaintiff
B) bailiff
C) attorney
D) defendant
Q3) Healthcare offices send out statements periodically;this process is typically called a _____ cycle.
A) periodic
B) collection
C) statement
D) billing
Q4) Collecting overdue accounts by phone is prohibited by law.
A)True
B)False
To view all questions and flashcards with answers, click on the resource link above. Page 16
Chapter 15: Keys to Successful Claims Management
Available Study Resources on Quizplus for this Chatper
60 Verified Questions
60 Flashcards
Source URL: https://quizplus.com/quiz/12098
Sample Questions
Q1) Not all medical practices follow the same strategy when it comes to the frequency of submitting insurance claims.What are some of the things that affect this process?
Q2) A suspension file is a series of files customarily set up:
A) alphabetically.
B) numerically.
C) phonetically.
D) chronologically.
Q3) Verifying a patient's healthcare coverage is an important duty of a health insurance professional.
A)True
B)False
Q4) Generally,if a claim is reduced or rejected,the problem lies with the: A) provider's office. B) patient.
C) insurance company.
D) fiscal intermediary.
Q5) Insurance companies usually have no time limits for filing appeals. A)True
B)False
To view all questions and flashcards with answers, click on the resource link above. Page 17
Chapter 16: The Role of Computers in Health Insurance
Available Study Resources on Quizplus for this Chatper
65 Verified Questions
65 Flashcards
Source URL: https://quizplus.com/quiz/12099
Sample Questions
Q1) The numbers used in the administration of healthcare to distinguish individual healthcare providers,health plans,employers,and patients are:
A) code sets.
B) identifiers.
C) EINs.
D) fax codes.
Q2) A(n)_____ acts as an intermediary between the medical facility and the insurance carrier.
A) EFT
B) EDI
C) EMR
D) clearinghouse
Q3) List two concerns with electronic medical records.
Q4) Both providers and patients want assurances that data transferred electronically does not become vulnerable and fall into the wrong hands.
A)True
B)False
Q5) List at least four of the six ways computers are commonly used today from a health insurance perspective.
To view all questions and flashcards with answers, click on the resource link above. Page 18
Chapter 17: Reimbursement Procedures: Getting Paid
Available Study Resources on Quizplus for this Chatper
72 Verified Questions
72 Flashcards
Source URL: https://quizplus.com/quiz/12100
Sample Questions
Q1) Most patient accounting systems available today are capable of performing the same basic system functions.
A)True
B)False
Q2) The typical length of stay for a patient classified to a long-term care (LTC)DRG is referred to as the:
A) APC.
B) GPCI.
C) ALOS.
D) ADL.
Q3) Relative weights (RWs)and arithmetic length of stay (ALOS)both impact DRGs.
A)True
B)False
Q4) HIPAA declared that ICD-9 diagnosis and procedure codes will be replaced by ICD-10 codes as of October 1,2014.
A)True
B)False
Q5) What format do the transaction standards of HIPAA specify for electronic transactions dealing with healthcare billing and payment?
To view all questions and flashcards with answers, click on the resource link above. Page 19
Chapter 18: Hospital Billing and the UB-04
Available Study Resources on Quizplus for this Chatper
89 Verified Questions
89 Flashcards
Source URL: https://quizplus.com/quiz/12101
Sample Questions
Q1) The process by which a fully informed patient can participate in choices about his or her healthcare is called:
A) recapitulation.
B) informed consent.
C) preauthorization.
D) certification.
Q2) Name the five major hospital payers discussed in the book and explain how a health insurance professional can obtain the most recent claims completion guidelines for each.
Q3) The hospital billing process begins when the patient is admitted to the facility.
A)True
B)False
Q4) Explain what a "covered entity" is and list three examples of organizations that fall under this classification.
Q5) As required by law,all general acute-care healthcare providers must identify whether a diagnosis was present upon an inpatient admission.
A)True
B)False
To view all questions and flashcards with answers, click on the resource link above.
Page 20