CAHIMS 1.2 2023 with complete solution questions and answers

Most people in the US get health insurance through: a. An employer b. Their county health department c. Their state health department d. The federal government a All of the following are privately funded EXCEPT: a. BlueCross Blue Shield b. Commercial insurers c. Managed care organizations d. The Children's Health Insurance Program d BlueCross BlueShield is: a. A managed care organization b. An association of private companies c. Funded by the federal government d. Funded by all 50 states b Managed care plans: a. Are much less common today than they were 50 years ago b. Combine health insurance and healthcare services c. Pay doctors on a fee-for-service basis d. All of the above b Of the following types of plans, costs for the patient are lowest, but choice of providers is most restricted, in a: a. Health maintenance organization b. Indemnity plan c. Preferred provider organization d. Point-of-service plan a What group determines whether someone is eligible for Medicare and processes their premium payments? a. The Centers for Medicare & Medicaid Services b. The Federal Insurance Contributions Agency c. The Social Security Administration d. The US Department of Health & Human Services c Choose the best statement about Medicaid and Medicare coverage: a. Medicaid covers older adults; Medicare covers people with low incomes. b. Medicaid covers people with low incomes; Medicare covers children and pregnant women in families that earn too much for Medicaid. c. Medicare covers older adults; Medicaid covers people with low incomes. d. Medicare covers all uninsured children and pregnant women; Medicaid covers older adults. c Which of the following statements is/are TRUE? a. Medicaid has different names in different states. b. Medicaid is funded by federal income taxes; c. Medicare is partially funded by individuals and their employers through payroll taxes; d. Some people on Medicaid also qualify for Medicare. e. All of the above e Samples of and electronic data interchange transaction include (choose all that apply): a. a fax copy of the claim b. CMS Form 1500 c. CMS Form 1450 d. 837 transaction for healthcare claims d Which of the following is currently used to code claims for healthcare services (choose all that apply): a. CPT b. ICD-9-CM c. NDC - National Drug Codes d. ICD-10-PCS a, b, c, d Which of the following is used for diagnosis coding and reporting on claims regardless of the provider? a. ICD-9 b. CPT c. HCPCS d. CDT a Fee-for-service payment type include (choose all that apply): a. episode-of-care b. traditional retrospective c. prospective payment d. global payment e. self-pay b, e The third party payer is a. the insured b. the provider c. the insurance company d. all of the above c Episode of care reimbursement types include all of the following except: a. self-pay b. prospective payment c. capitation d. global payment a Managed care reimbursement may be paid using which of the following methods: a. fee-for-service b. episode-of-care c. either fee-for-service or episode-of-care d. none of the above c The sectors of healthcare spending that utilize the most resources include (choose all that apply): a. hospitals b. physician services c. pharmaceutical costs d. nursing homes a, b, c Which of the following is not considered a chronic disease? a. hypertension or high blood pressure b. diabetes c. asthma d. influenza d The age group associated with the highest medical expenses is: a. children 5 b. adults age 25-44 c. adults age 45-64 d. adults 65 d The EMTALA act requires hospitals receiving federal funds to evaluate individuals presenting to the emergency department a. only if they have insurance b. regardless of their ability to pay c. only if they pay in advance d. only if it is a true emergency b (Choose all that apply) Factors that contribute to escalating healthcare expenditures in the US include: a. Technology. b. Chronic disease. c. Increased demand and utilization. d. An excess of primary care doctors. e. New pharmaceutical treatments. f. Administrative costs. g. The uninsured. a, b, c, e, f, g