NHA CMAA Practice Exam #35

NHA CMAA Practice Exam #35 adjuster Ans-A person who represents either party of an insurance claim is the: A. doctor B. adjuster C. provider D. subscriber claim Ans-A request for payment under an insurance contractor bond is called a(n): A. insurance application B. claim C. dual choice request D. total disability premium Ans-Payment made periodically to keep an insurance policy in force is called: A. time limit B. premium C. coinsurance D. fee for service provider Ans-A person or institution that gives medical care is a(n): A. third-party payer B. provider C. adjuster D. insurance agent indemnities Ans-Benefits that are made in the form of cash payments are known as: A. indemnities B. deductibles C. medical co-pays D. cash advances deductible Ans-An amount the insured must pay before policy benefits begin is called: A. indemnity B. extended benefits C. deductible D. catastrophic health maintenance organization Ans-An organization that offers health insurance at a fixed monthly premium with little or no deductible and works through a primary care provider is called a(n): A. preferred provider B. health maintenance organization C. member physician D. private health provider outpatient Ans-A patient receiving ambulatory care at a hospital or other health facility without being admitted a bed patient is called a(n): A. inpatient B. outpatient C. carrier D. adjuster partial disability Ans-An injury that prevents a worker from performing one or more of the regular functions of his job would be known as a : A. partial disability B. permanent disability C. total disability D. resultant disability subscriber Ans-One who belongs to a group insurance plan is called: A. third-party payer B. subscriber C. carrier D. no correct answer benefits Ans-A sum of money provided in an insurance policy, payable for covered services is called: A. deductible B. benefits C. dues payable D. premium coordination of benefits Ans-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 D. non duplication benefits coinsurance Ans-When a patient has health insurance, the percentage of covered services that is the responsibility of the patient to pay is known as: A. coinsurance B. pre-defined policy C. comprehensive D. in percent policy intervening cause Ans-A defense against malpractice may include acts of independent agents that stand in the way of the causal connection between the negligent act and the damage suffered. This is called A. comparative negligence B. tolling of the statute of limitations C. intervening cause D. assumption of the risk E. contributory negligence accident Ans-An unexpected event which may cause injury is called: A. dread disease rider B. accident C. adjuster D. no correct answer participating physician Ans-A doctor who agrees to accept an insurance companies pre-established fee as the maximum amount to be collected is called: A. subscriber B. claim representative C. participating physician D. adjuster time limit Ans-A notice of insurance claim or proof of loss must be filed within a designated_________ or it can be denied: A. waiting period B. policy date C. time limit D. grace period Medicare Ans-A health program for people age 65 and older under social security is called: A. TRICARE B. Medicare C. Champva D. Workers' Compensation Worker's Compensation Ans-A form of insurance paid by the employer providing cash benefits to workers injured or disabled in the course of employment is called: A. Tri-Care B. Champus C. Worker's Compensation D. Medicaid co-payment Ans-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 called: A. co-payment B. coordination of benefits C. deductible D. indemnity comprehensive Ans-In insurance, greater coverage of diseases or an accident, and greater indemnity payment in comparison with a limited clause is called: A. co-payment B. comprehensive C. deductible D. major medical dread disease rider Ans-A rider added to a policy to provide additional benefits for certain conditions is called: A. hospital benefits B. dread disease rider C. pre-existing condition D. no correct answer assignment of benefits Ans-An agreement by which a patient assigns to another party the right to receive payment from a third party for the service the patient has received is called: A. assignment of benefits B. coordination of benefits C. non duplication of benefits D. no correct answer extended care facility Ans-A skilled nursing facility for patients receiving specialized care after discharge from a hospital called: A. extended care facility B. post care facility C. nursing home D. no correct answer hospital benefits Ans-Payment for hospital charges incurred by an insured person because of injury or illness is called: A. hospital benefits B. catastrophic health benefits C. extra help benefits D. no correct answer insurance agent Ans-An agent of an insurance company who solicits or initiates contracts for insurance coverage and services, and is the policy holder for the insurer is called: A. insurance agent B. claim representative C. carrier D. member physician fee-for-service Ans-A method of charging whereby a physician presents a bill for each service rendered is called: A. non duplication of benefits B. fee-for-service C. monthly statement D. no correct answer w-4 Ans-The number on the Employees Withholding Exemption Certificate is: A. w-2 B. w-4 C. 1040 D. w-3 checkbook Ans-As part of the office bookkeeping procedures, the physician's bank statement should be reconciled with the : A. daily ledger B. business ledger C. personal ledger D. checkbook deposit slip Ans-A form to itemize deposits made to savings or checking accounts is called: A. deposit slip B. money order C. check guarantee D. no correct answer Medicaid Ans-Low income patients can be covered by what type of insurance? A. Medicaid B. Medicare C. Tri-Care D. Blue Cross/Blue Shield Pre-certification Ans-________ is a method used for determining whether a particular service or procedure is covered under a patient's polic