TEST BANK
Beik's Health Insurance Today
Julie K. Pepper
8th Edition
,Table of Contents
Chapter 01 The Origins of Health Insurance 1
Chapter 02 Tools of the Trade-A Career as a Health (Medical) Insurance Professional 7
Chapter 03 The Legal and Ethical Side of Health Insurance 13
Chapter 04 Healthcare Reform-Coverage Types and Sources 23
Chapter 05 The Patient and the Billing Process 30
Chapter 06 Claim Submission Methods 40
Chapter 07 Claims Management 51
Chapter 08 Reimbursement Models 60
Chapter 09 The Changing Face of Managed Care 68
Chapter 10 Understanding Medicaid 76
Chapter 11 Conquering Medicare’s Challenges 88
Chapter 12 Military Carriers 102
Chapter 13 Miscellaneous Carriers-Workers’ Compensation and Disability Insurance 113
Chapter 14 Diagnostic Coding 122
Chapter 15 Procedural, Evaluation and Management, and HCPCS Coding 139
Chapter 16 The Role of Computers in Health Insurance 158
Chapter 17 Reimbursement Procedures-Getting Paid 168
Chapter 18 Hospital Billing and the UB-04 179
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Test Bank - Beik's Health Insurance Today, 8th Edition (Pepper, 2024)
Chapter 01: The Origins of Health Insurance
Beik: Health Insurance Today: A Practical Approach, 8th Edition
MULTIPLE CHOICE
1. The business of protecting, through legal means, a person or property against loss or harm is
referred to as
a. prevention.
b. insurance.
c. a contract.
d. preclusion.
ANS: B TOP: What is Insurance?
2. Health insurance narrows down undesirable events to
a. illnesses and injuries.
b. automobile accidents.
c. preventive illnesses.
d. preexisting conditions.
ANS: A TOP: What is Insurance?
3. Securitas is the Latin term for
a. services.
b. specialist.
c. security.
d. success.
ANS: C TOP: History
4. In the United States, the “birth” of health insurance occurred in
a. 1889.
b. 1900.
c. 1915.
d. 1929.
ANS: D TOP: History
5. The federal healthcare program for the elderly and certain qualifying others is
a. Medicare.
b. Medicaid.
c. Blue Cross.
d. health maintenance.
ANS: A TOP: Metamorphosis of Health Insurance
6. The combined federal and state healthcare program for indigent and low-income individuals is
a. Medicare.
b. Medicaid.
c. Blue Cross.
d. health maintenance.
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Test Bank - Beik's Health Insurance Today, 8th Edition (Pepper, 2024)
ANS: B TOP: Metamorphosis of Health Insurance
7. One of the 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).
ANS: C TOP: Metamorphosis of Health Insurance
8. Congress passed the Health Maintenance Organization Act in
a. 1950.
b. 1965.
c. 1973.
d. 1987.
ANS: C TOP: Metamorphosis of Health Insurance
9. Factors listed in the text that drive healthcare issues include all of the following except
a. regulating managed care plans.
b. expanding access for uninsured Americans.
c. increasing genetic testing.
d. stabilizing emergency services.
ANS: C TOP: Key Health Insurance Issues
10. Many employed individuals obtain healthcare coverage through a/an
a. group plan.
b. individual policy.
c. government-sponsored program.
d. guaranteed insurance pool.
ANS: A TOP: Access to Health Insurance
11. A set of government-regulated, standardized plans eligible for federal subsidies from which
individuals can purchase low-cost health insurance.
a. COBRA plans
b. Health insurance exchanges
c. Indemnity plans
d. Managed care plans
ANS: B TOP: Patient Protection and Affordable Care Act
12. The acronym for the congressional act that standardized electronic data interchange and
enhanced confidentiality and security of patient information as well as other health-related
matters is
a. AMA.
b. COBRA.
c. HIPAA.
d. EMTLA.
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Test Bank - Beik's Health Insurance Today, 8th Edition (Pepper, 2024)
ANS: C TOP: Health Insurance Portability and Accountability Act
13. The situation in which patients pay a certain portion of healthcare costs (e.g., deductible and
copayment) is called
a. cost-sharing.
b. equalizing.
c. standardizing.
d. community rating.
ANS: A TOP: Cost-sharing
14. A system of healthcare payment or delivery arrangements in which the plan attempts to
control the use of services by its enrolled members to contain expenditures and/or improve
quality.
a. Managed healthcare
b. Fee-for-service
c. Health insurance exchange
d. Indemnity insurance
ANS: A TOP: Basic Health Insurance Plans
15. Fee-for-service healthcare plans are also referred to as
a. managed care.
b. preventive plans.
c. indemnity insurance.
d. health maintenance organizations.
ANS: C TOP: Basic Health Insurance Plans
16. The Patient Protection and Affordable Care Act was passed in
a. 1999.
b. 2005.
c. 2008.
d. 2010.
ANS: D TOP: Metamorphosis of Health Insurance
17. The “graying of America” refers to those who
a. are 65 years of age or older.
b. work in “blue collar” jobs.
c. do not have a high school diploma.
d. are not American citizens.
ANS: A TOP: Americans Are Living Longer Than Ever Before
18. Which of the following is not a provision of HIPAA?
a. Allows portability of health insurance coverage
b. Protects workers and their families from preexisting conditions
c. Establishes national standards for electronic healthcare
d. Addresses the high cost of health insurance
ANS: D TOP: Health Insurance Portability and Accountability Act
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Test Bank - Beik's Health Insurance Today, 8th Edition (Pepper, 2024)
19. The program that provides insurance for qualifying children who are ineligible for Medicaid
but cannot afford private insurance is called
a. CHIP.
b. COBRA.
c. ARRA.
d. HIPAA.
ANS: A TOP: State Programs for the Uninsured
20. Recent healthcare reform has introduced two new types of healthcare plans that the text
mentions are “on the horizon” are
a. Medicare and Medicaid.
b. Health Insurance Exchanges and Accountable Care Organizations.
c. SCHIP and COBRA.
d. HMOs and HIPAA.
ANS: B TOP: Basic Health Insurance Plans
COMPLETION
1. The amount of money an individual pays in return for health insurance coverage is called a/an
____________________.
ANS: premium
TOP: What is Health Insurance?
2. The transformation of health insurance from what it was in the beginning to what we know it
to be today can be compared with an organic process referred to as __________.
ANS: metamorphosis
TOP: Metamorphosis of Health Insurance
3. In 1850, the Franklin Health Assurance Company began offering medical expense coverage,
similar to today’s health insurance, in the state of ____________________.
ANS: Massachusetts
TOP: History
4. The out-of-pocket expense that patients must pay before insurers begin paying benefits is
called a/an ____________________.
ANS: deductible
TOP: Metamorphosis of Health Insurance
5. A condition or illness that is in existence before an individual’s healthcare coverage begins is
called a/an ____________________.
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Test Bank - Beik's Health Insurance Today, 8th Edition (Pepper, 2024)
ANS: preexisting condition
TOP: Patient Protection and Affordable Care Act
6. The type of healthcare policy that a business entity frequently offers its employees is called
a/an ___________________ policy.
ANS: group
TOP: Metamorphosis of Health Insurance
7. Healthcare plans that provide cost-effective care while attempting to contain expenditures are
referred to as ____________________.
ANS: managed healthcare
TOP: Basic Health Insurance Plans
8. The federal act that allows employees who quit their jobs or get laid off to extend their group
coverage is known by the acronym ___________________.
ANS: COBRA
TOP: The Affordable Care Act and Consolidated Omnibus Budget Reconciliation Act
TRUE/FALSE
1. Healthcare providers and companies that sell insurance have determined it is less costly to
prevent serious illnesses than to treat them after they emerge.
ANS: T TOP: What is Insurance?
2. Justin Ford Kimball introduced a health plan in Dallas in 1929 that evolved into what is
known today as Medicare.
ANS: F TOP: History
3. Usually, there are no deductibles to be met or claim forms to be completed with HMOs.
ANS: T TOP: Metamorphosis of Health Insurance
4. A health insurance exchange is an organized and competitive market that offers a choice of
plans with common rules governing cost and provides information so consumers can
understand the choices available to them.
ANS: T TOP: Access to Health Insurance and the Law
5. Under HIPAA, employees who quit their jobs or are laid off can extend their group healthcare
coverage for up to 5 years.
ANS: F
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Test Bank - Beik's Health Insurance Today, 8th Edition (Pepper, 2024)
TOP: The Affordable Care Act and Consolidated Omnibus Budget Reconciliation Act
6. One of the factors that drives up healthcare costs is the fact that Americans are living longer
than ever before.
ANS: T TOP: Americans Are Living Longer Than Ever Before
7. Media coverage is instrumental in keeping healthcare costs down.
ANS: F TOP: Media Intervention
8. Under the new healthcare law, ACOs agree to manage all of the healthcare needs of a
minimum of 5,000 Medicare beneficiaries for at least 3 years.
ANS: T TOP: Basic Health Insurance Plans
9. Medicare provides healthcare coverage for qualifying low-income individuals.
ANS: F TOP: Basic Health Insurance Plans
10. The two basic types of health insurance plans are indemnity and managed care.
ANS: T TOP: Basic Health Insurance Plans
11. Because health insurance is constantly evolving, there will no doubt always be issues to face,
such as keeping costs down and preventing chronic illnesses.
ANS: T TOP: Key Health Insurance Issues
12. Individuals who are employed by a business are always covered by a group healthcare plan.
ANS: F TOP: Metamorphosis of Health Insurance
13. The Affordable Care Act does not eliminate or affect COBRA.
ANS: T
TOP: The Affordable Care Act and Consolidated Omnibus Budget Reconciliation Act
14. The new healthcare reform laws make it more difficult for Americans to qualify for state
Medicaid programs.
ANS: F TOP: State Programs for the Uninsured
15. With the passage of the Affordable Care Act, insurance companies can deny coverage to
children with preexisting illnesses until they are 18 years old.
ANS: F TOP: Metamorphosis of Health Insurance
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Test Bank - Beik's Health Insurance Today, 8th Edition (Pepper, 2024)
Chapter 02: Tools of the Trade: A Career as a Health (Medical) Insurance Professional
Beik: Health Insurance Today: A Practical Approach, 8th Edition
MULTIPLE CHOICE
1. Understanding what you read is called
a. application.
b. comprehension.
c. communication.
d. interpretation.
ANS: B TOP: Required Skills and Interests
2. Sending and receiving information through mutually understood methods is called
a. application.
b. comprehension.
c. communication.
d. interpretation.
ANS: C TOP: Required Skills and Interests
3. When you stick with a task until it is completed, you are
a. diligent.
b. reticent.
c. obstinate.
d. obedient.
ANS: A TOP: Preparation
4. When you have honest, ethical, and moral principles, you are said to have
a. objectivity.
b. practicality.
c. flexibility.
d. integrity.
ANS: D TOP: Preparation
5. If you are not influenced by personal feelings, biases, or prejudice, you have
a. objectivity.
b. practicality.
c. flexibility.
d. integrity.
ANS: A TOP: Preparation
6. To write down important lecture facts in one’s own words is called
a. outlining.
b. plagiarizing.
c. documenting.
d. paraphrasing.
ANS: D TOP: Preparation
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Test Bank - Beik's Health Insurance Today, 8th Edition (Pepper, 2024)
7. Organizing daily responsibilities according to their importance is called
a. colonizing.
b. multitasking.
c. prioritizing.
d. categorizing.
ANS: C TOP: Preparation
8. College entry-level skills necessary for success as a health insurance professional include all
of the following, except
a. coding.
b. basic business math.
c. English and grammar skills.
d. keyboarding and computer skills.
ANS: A TOP: Required Skills and Interests
9. Success in getting the most out of one’s education and optimizing career potential facilitates
a. lifelong learning.
b. autonomy.
c. career identity.
d. individuality.
ANS: A TOP: Preparation
10. In order to develop effective study skills, it is suggested that students generate a _________
chart.
a. career objective
b. time management
c. professional education
d. goal-oriented
ANS: B TOP: Preparation
11. The nationally recognized job title for individuals who specialize in medical insurance claims
submission is
a. insurance billing specialist.
b. health insurance professional.
c. health information technician.
d. none; there is no nationally recognized title.
ANS: D TOP: Job Duties and Responsibilities
12. One method of enhancing one’s career as a health insurance professional is to acquire
a. certification.
b. nationalization.
c. legalization.
d. specialization.
ANS: A TOP: Your Future as a Health Insurance Professional
13. Many of those who work in healthcare say the most important reward is
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