SOLVED

11)Third-party payers are covered by both state and federal regulations. Two of the federal regulations are: A)COBRA and PPO. B)ERISA and HIPAA. C)COBRA and EPO. D)ERICA and HIPAA. 12)A policy is: A)a binding contract between the payer and the employer. B)the time in which employees can utilize benefits. C)a time when employees can change providers. D)a binding contract between the payer and the employee. 13)An enrollment period is a: A)binding contract between the payer and the employee. B)binding contract between the payer and employer. C)time when employees can utilize benefits. D)time when employees can change providers. 14)Determining who is responsible for health claim payments is known as: A)explanation of benefits. B)COBRA. C)coordination of benefits. D)ERISA. 15)John is known as a(n) _______________ in his HMO. A)actuary B)enrollee C)subscriber D)policy holder 16) Which of the following describes Blue Cross/Blue Shield? A)A health insurance company. B)Blue Cross pays hospital expenses. C)Blue Shield pays physician expenses. D)All of the above 17)All of the following are true about the Healthcare Common Procedure Coding System (HCPCS) except: A) it consists of two levels. B)the current procedural terminology (CPT) is for procedures and services performed by providers. C)it involves indemnification. D)the national codes (HCPCS level II codes) are for procedures, services, and supplies not found in CPT. 18)A third-party payer may be: A) an insurance company. B)a government agency. C)a service provider. D)All of the above 19)With EPOs all of the following are true except: A)patients must select their care providers from those in the network. B)patients may choose their physician or hospital. C)if the patient chooses to go outside the network the services are not covered. D)they are regulated by state insurance law. 20)A PPO: A)is a delivery network. B)does not receive premiums or assume financial risk. C)decreases cost of service if a preferred provider is used. D)All of the above 21)All of the following are true except: A)22 states insist on mental health parity. B)all 50 states mandate breast cancer screening. C)16 states mandate payment of prenatal care. D)44 states require external review of health plan decisions. 22) A ______________________ is a system where payment is made in advance of services being provided. A)prepaid health plan B)preauthorization C)coordination of benefits D)copayment 23)HIPAA regulates all of the following except: A)portability. B)coverage on a family plan until 26 years old. C)access. D)mandated benefits. 24)The American Health Benefit Exchanges and Small Business Health Option Exchanges: A) are part of the Patient Protection and Affordable Care Act. B)require states to establish insurance options for the uninsured and small businesses. C)require states to establish an office of health insurance consumer assistance. D)All of the above 25)Prepaid health plans:Â A)are attractive to employers because they know in advance what the cost of providing health care will be. B)all involve an IPO. C)are attractive to the service provider because the number of patients is fixed and a certain revenue level is guaranteed. D)Both A and C