MEDICAL OFFICER Multiple Choice Questions :-

1) a bed patient in a hospital is called a

A. inpatient (Correct Answer)
B. outpatient
C. third party payer
D. provider
Ans: A

2) one who acts for the insured or the carrier in a claim is called

A. doctor
B. adjuster (Correct Answer)
C. provider
D. subscriber
Ans: B

3) a request for payment under an insurance contractor bond is called a(an)

A. insurance application
B. claim (Correct Answer)
C. dual choice request
D. total disability
Ans: B

4) payment made periodically to keep an insurance policy in force is called

A. time limit
B. premium (Correct Answer)
C. coinsurance
D. fee for service
Ans: B

5) a person or institution that gives medical care is an

A. third party payer
B. provider (Correct Answer)
C. adjuster
D. insurance agent
Ans: B

6) Benefits in the form of cash payments rather than service are called

A. indemnity (Correct Answer)
B. hospital benefits
C. catastrophic health benefits
D. cash advances
Ans: A

7) An Amount the insured must pay before policy benefits begin is called

A. indemnity
B. extended benefits
C. deductible (Correct Answer)
D. catastrophic
Ans: C

8) an organization that offers insurance against losses in exchange for a premium is called a

A. rider
B. health maintenance organization (Correct Answer)
C. member physician
D. bank
Ans: B

9) health insurance that provides protection against the high cost of treating severe or lengthy illnesses or disabilities is called

A. catastrophic (Correct Answer)
B. severe
C. third party payer
D. none of the above
Ans: A

10) a patient receiving ambulatory care at a hospital or other health facility without being admitted as a bed patient is called a (an)

A. inpatient
B. outpatient (Correct Answer)
C. carrier
D. adjuster
Ans: B

11) an illness of injury that prevents an insured person from performing one or more of the functions of his regular job is called

A. partial disability (Correct Answer)
B. permanent disability
C. total disability
D. resultant disability
Ans: A

12) a previous injury disease or physical condition that existed before the health insurance policy was issued is called

A. preexisting condition (Correct Answer)
B. prior exposure
C. foregoing condition
D. none of the above
Ans: A

13) one who belongs to a group insurance plan is called

A. third party payer
B. subscriber (Correct Answer)
C. carrier
D. none of the above
Ans: B

14) a sum of money provided in an insurance policy, payable for covered services is called

A. deductible
B. benefits (Correct Answer)
C. dues payable
D. premium
Ans: B

15) to prevent the insured from receiving a duplicate payment for losses under more than one insurance policy is called

A. fee for service
B. hospital benefits
C. coordination of benefits (Correct Answer)
D. non duplication benefits
Ans: C

16) a requirement under a health care policy dictated that the insured be responsible for a percentage of covered services, this is called

A. coinsurance (Correct Answer)
B. pre defined policy
C. comprehensive
D. in percent policy
Ans: A

17) Insurance designed to offset medical expenses resulting from catastrophic or prolonged illness or injury is called

A. primary insurance
B. major medical (Correct Answer)
C. whole life policy
D. comprehensive
Ans: B

18) An unexpected event which may cause injury is a(n)

A. dread disease rider
B. accident (Correct Answer)
C. adjuster
D. none of the above
Ans: B

19) A doctor who agrees to accept an insurance companies pre-established fee as the maximum amount to be collected is a(n)

A. subscriber
B. claim representative
C. participating physician (Correct Answer)
D. adjuster
Ans: C

20) Insurance plans that pay a physician’s full charge if it does not exceed his normal charge or does not exceed the amount normally charged for the service is

A. usual, customary, and reasonable (Correct Answer)
B. comprehensive
C. dual choice
D. none of the above
Ans: A

21) The period of the time in which a notice of claim or proof of loss must be filed is a(n)

A. waiting period
B. policy dates
C. time limit (Correct Answer)
D. grace period
Ans: C

22) A health program for people age 65 and older under social security is

A. tri-care
B. medicare (Correct Answer)
C. champva
D. worker’s compensation
Ans: B

23) A Civilian health and medical program of the uniform services is

A. Tri-care (Correct Answer)
B. medicare
C. medicaid
D. worker’s compensation
Ans: A

24) A form of insurance paid by the employer providing cash benefits to workers injured or disabled in the course of employment is

A. Tri-care
B. Champus
C. Worker’s Compensation (Correct Answer)
D. Medicaid
Ans: C

25) A recap sheet that accompanies a medicare or medicaid check, showing breakdown and explanation of payment on a claim is a(n)

A. fee for service
B. explanation of benefits (Correct Answer)
C. coordination of benefits
D. dual choice
Ans: B

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26) a type of insurance whereby the insured pays a specific amount per unit of service and the insurer pays the rest of the cost is a(n)

A. co-payments (Correct Answer)
B. coordination of benefits
C. deductible
D. indemnity
Ans: A

27) In Insurance, greater coverage of diseases or an accident and greater indemnity payment in comparison with a limited clause is a(n)

A. co-payment
B. comprehensive (Correct Answer)
C. deductible
D. major medical
Ans: B

28) a rider added to a policy to provide additional benefits for certain conditions is a(n)

A. hospital benefits
B. dread disease rider (Correct Answer)
C. preexisting condition
D. none of the above
Ans: B

29) An interval after a payment is due to the insurance company in which the policy holder may make payments, and still the policy remains in effect is a(n)

A. extended benefits
B. grace period (Correct Answer)
C. coordination of benefits
D. lapse time
Ans: B

30) An agreement by which a patient assigns to another party the right to receive payment from a third party for the services the patient has received is a(n)

A. assignment (Correct Answer)
B. coordination of benefits
C. non duplication of benefits
D. none of the above
Ans: A

31) a skilled nursing facility for patients receiving specialized care after discharge from a hospital is a(n)

A. extended care facility (Correct Answer)
B. post care facility
C. nursing home
D. none of the above
Ans: A

32) Payment for hpspital charges incurred by an insured person because of injury or illness is a(n)

A. hospital benefits (Correct Answer)
B. catastrophic health benefits
C. extra help benefits
D. none of the above
Ans: A

33) An agen of an insurance company who solicits or initiates contracts of insurance and services the policyholder for the insurer is a(n)

A. insurance agent (Correct Answer)
B. claim representative
C. carrier
D. member physician
Ans: A

34) A method or charging whereby a physician presents a bill for each service rendered is a(n)

A. non duplication of benefits
B. fee for service (Correct Answer)
C. monthly statement
D. none of the above
Ans: B

35) The Tri-care fiscal begins ________ and ends ________

A. January 1 to December 31
B. October 1 to September 1
C. October 1 to September 30 (Correct Answer)
D. July 1 to june 31
Ans: C

36. What is a Procedure Code?
a) a software program that automates many of the administrative and financial tasks in a medical practice
b) private or government organization that insures or pays for health care on behalf of beneficiaries
c) a code that identifies a medical service
d) a person or entity who buys an insurance plan; the insured
Ans: c
37. What is a Statement?
a) amount due before benefits start
b) a list of all services performed for a patient, along with the charges for each service
c) an explanation of benefits transmitted electronically by a payer to a provider
d) a code that identifies a medical service
Ans: b

38. What is a Diagnosis?
a) physician’s opinion of the nature of the patient’s illness or injury
b) amount due before benefits start
c) a person or entity who buys an insurance plan; the insured
d) None of the above
Ans: a

39. What is a Practice Management Program (PMP)?
a) a software program that automates many of the administrative and financial tasks in a medical practice
b) physician’s opinion of the nature of the patient’s illness or injury
c) a code that identifies a medical service
d) a person or entity who buys an insurance plan; the insured
Ans: a

40. What is a Documentation?
a) physician’s opinion of the nature of the patient’s illness or injury
b) a record of health care encounters between the physician and the patient, created by the provider
c) a person or entity who buys an insurance plan; the insured
d) physician’s opinion of the nature of the patient’s illness or injury
Ans: a

41. What is a Health Plan?
a) a code that identifies a medical service
b) a list of the procedures and charges for a patient’s visit
c) a person or entity who buys an insurance plan; the insured
d) a plan, program, or organization that provides health benefits
Ans: d

42. What is a Medical Record?
a) a chronological record of a patient’s medical history and care that includes information that the patient provides, as well as the physician’s assessment, diagnosis, and treatment plan
b) monies that are flowing into a business
c) physician’s opinion of the nature of the patient’s illness or injury
d) a code that identifies a medical service
Ans: a

43. What is a Payer?
a) physician’s opinion of the nature of the patient’s illness or injury
b) private or government organization that insures or pays for health care on behalf of beneficiaries
c) a list of all services performed for a patient, along with the charges for each service
d) a chronological record of a patient’s medical history and care that includes information that the patient provides, as well as the physician’s assessment, diagnosis, and treatment plan
Ans: b

44. What is a Accounts Receivable (AR)?
a) amount due before benefits start
b) monies that are flowing into a business
c) a code that identifies a medical service
d) treatment provided by a physician to a patient for the purpose of preventing, diagnosing, or treating an illness, injury, or its symptoms in a manner that is appropriate and is provided in accordance with generally accepted standards of medical practice
Ans: b

45. What is a Policyholder?
a) a plan, program, or organization that provides health benefits
b) a person or entity who buys an insurance plan; the insured
c) monies that are flowing into a business
d) a plan, program, or organization that provides health benefits
Ans: b

46. What is meant by Medical Necessity?
a) physician’s opinion of the nature of the patient’s illness or injury
b) monies that are flowing into a business
c) a plan, program, or organization that provides health benefits
d) treatment provided by a physician to a patient for the purpose of preventing, diagnosing, or treating an illness, injury, or its symptoms in a manner that is appropriate and is provided in accordance with generally accepted standards of medical practice
Ans: d

47. What is meant by Remittance Advice (RA)?
a) an explanation of benefits transmitted electronically by a payer to a provider
b) a fixed fee paid by the patient at the time of an office visit
c) monies that are flowing into a business
d) a software program that automates many of the administrative and financial tasks in a medical practice
Ans: a

48. What is Copayment?
a) a code that identifies a medical service
b) a chronological record of a patient’s medical history and care that includes information that the patient provides, as well as the physician’s assessment, diagnosis, and treatment plan
c) a fixed fee paid by the patient at the time of an office visit
d) a person or entity who buys an insurance plan; the insured
Ans: c

49. What is meant by Encounter Form?
a) a list of the procedures and charges for a patient’s visit
b) a software program that automates many of the administrative and financial tasks in a medical practice
c) a person or entity who buys an insurance plan; the insured
d) an explanation of benefits transmitted electronically by a payer to a provider
Ans: a

50. What is meant by Deductible?
a) private or government organization that insures or pays for health care on behalf of beneficiaries
b) a list of all services performed for a patient, along with the charges for each service
c) amount due before benefits start
d) a software program that automates many of the administrative and financial tasks in a medical practice
Ans: c

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