Question

AH Sfganization that processes claims and provides administrative services for another organization is utilization management. b. resource-based relative value system. third-party administrator. d. provider network. a. C. 37. The Affordable Care Act includes which of the following categories of essential health benefins a. Emergency services b. Laboratory services c. Prescription drugs d. All of the above 38. Services that are needed to improve the patient's current health are considered a. elective. b. preventive. c. medically necessary. d. provider network. 39. Service provided to stop certain conditions from occurring or to lead to an carly diagnosis are considered elective. b. preventive. c. medically necessary. d. provider network. a. 40. Which part of Medicare covers inpatient hospital charges? Part A b. Part B Part C d. Part D a. c. 41. The allowed amount for Medicare charges is determined using fee schedule. b. resource-based relative value scale. utilization management. d. provider network. c. RBRVS consists of three parts, including which of the following? Provider work 42. b. Charge-based professional liability expenses c. Charge-based overhead d. All of the above a. 43. The health insurance model that offers the most flexibility for patients is a. traditional health insurance. b. managed care organizations.

Answer 1

Q36.

(C) third-party administrator

An organization that processes claims and provide administrative services for another organization is third-party administrator. It is a company that functions in operational services such as the employee benefit management and the processing of claims.

Q37.

(D) All of the above

The affordable care act includes a total of 10 essential health benefits. These health benefits include preventive and wellness visits, mental health treatment, lab tests, maternity and newborn care, devices and services to help patients with injury, chronic conditions and disabilities, pediatric care, outpatient care, hospitalization, emergency services and prescription drugs.

Q38

(C) Medically necessary

Services that are needed to improve current health of the patient is considered as medically necessary services. These are used to diagnose and treat the patient’s condition.

Q39

(B) Preventive services

The preventive services are provided to stop a particular condition or illness from occurring or to bring up early diagnosis. These services consists of interventions that prevent a future event or that can make the patient’s condition worse.

Q40.

1. Part A

The inpatient hospital charges are covered in the part A of Medicare. It is the part of hospital insurance and it enable the user to pay a one-time deductible for first 60 days of the hospital services.

Q41. (B) resource-based relative value scale

The allowed amount of Medicare charges is determined using RBRVS. It is a scheme that is used to determine the money that is paid to the medical providers.

Q42. (A) Provider work

RBRVS consists of three parts which are provider work, professional liability insurance and practice expense.

Q43. The health insurance model that offer the most flexibility for patients is preferred provider organization