NAME: ________________________

Health Insurance Test

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5 Written Questions

5 Matching Questions

  1. Gatekeeper:
  2. Health Maintenance Organization (HMO):
  3. Utilization review:
  4. Preauthorization:
  5. Workers' Compensation it was called:
  1. a grants prior approval for reimbursement of a healthcare service
  2. b providing essential healthcare services at the lowest possible cost, avoiding nonessential care, and referring patients to specialists.
  3. c provides comprehensive healthcare services to voluntarily enrolled members on a prepaid basis
  4. d method of controlled healthcare cost & quality of care by reviewing the appropriateness & necessity of care provided to patients prior administration of case
  5. e 1908 - workmen compensation

5 Multiple Choice Questions

  1. S-Subjective
  2. amount for which the patient is financially responsible before insurance policy provides coverage
  3. prior approval
  4. which describes patient encounters with provides for the purpose of evaluation & management of general health status.
  5. reimbursement methodology that increases payment if the healthcare service fees increase, if multiple units of service are provided, or if more expensive services are provided instead of less expensive services

5 True/False Questions

  1. International Classification of Diseases (ICD):organization of affiliated providers' sites that offer joint healthcare services to subscribers


  2. Group Health Insurancethe percentage the patient pays for covered services after the deductible has been met & the copayment has been paid


  3. First Health Insurance Policy in1860 by The Franklin Health Assurance Company of Massachusetts was the first commercial insurance company in the US to provide private healthcare coverage for injuries not resulting in death.


  4. 1984 Standardization of information submitted on Medicare claims:1973


  5. Capitation:provider accepts preestablished payments for providing healthcare services to enrollness over a period of time (usually one year)


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