U.S. Healthcare & Health Insurance Mastery Exam: Medicare Parts A/B/C/D,
Medicaid, CHIP, TRICARE, CHAMPVA; Managed Care Systems (HMO, PPO, POS,
EPO); Reimbursement & Payment Methodologies (DRG, MS-DRG, APC, IPPS,
OPPS, SNF PPS, IRF PPS, LTCH PPS, HH PPS); Medical Billing, Coding &
Documentation (ICD, CPT, HCPCS, EHR, EMR, SOAP, MDS, OASIS, IRF PAI);
Healthcare Compliance & Legislation (HIPAA, COBRA, ERISA, HITECH, PPACA,
HCERA, MACRA, MIPPA); Cost-Sharing & Patient Financial Responsibility
(Deductible, Copayment, Coinsurance, Premiums); Utilization Review,
Preauthorization, Referrals, Risk Pools, Consumer-Driven Health Plans,
Accreditation, Quality Measures (HEDIS, NCQA, QISMC, EQRO); Physician Fee
Schedules & Case-Mix Index Exam Questions Verified and Provided with
Complete A+ Graded Rationales Latest Updated 2026
Welcome back to Dr. Erickson's office. In your position here, you communicate with patients
about their insurance benefits every day. You are responsible for obtaining accurate insurance
information from patients and explaining fees for their health care. As you review the following
scenarios, consider the importance of understanding basic health insurance terminology.
1a. A patient states, "I haven't met my deductible yet, and I'm afraid that this procedure will
cost a lot." What does the patient mean?
a. The patient doesn't have insurance.
b. The patient hasn't paid their copayment.
,c. The patient doesn't have the funds to pay for the procedure.
d. The patient hasn't paid the necessary amount for health care before the insurance company
will pay.
d. the patient hasn't paid the necessary amount for health care before the insurance company
will pay.
1b. You request a $30 copayment from the patient. The patient asks what a copayment is. What
do you say?
a. "A copayment is a percentage of the cost of the visit."
b. "A copayment is the total amount due for your visit."
c. "A copayment is a specific dollar amount you must pay for each visit or service received."
d. "A copayment is the amount our office charges for each visit."
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c. "A copayment is a specific dollar amount you must pay for each visit or service received."
1c. A patient calls to schedule an appointment for themself. While obtaining their health
insurance information, you ask who the policyholder is. They state, "I'm not sure, my spouse or
me, I guess." What do you say next?
a. "The policyholder is the person that selected the health insurance policy. Would that be you
or your spouse?"
b. "The policyholder is the person who has signed a contract with the health insurance company
and owns the health insurance policy. Would that be you or your spouse?"
c. "The policyholder is the person who is receiving health care and who is covered by the health
insurance plan. I will list you as the policyholder."
d. "Thank you. I will list you both as the policyholder."
b. "The policyholder is the person who has signed a contract with the health insurance company
that owns the health insurance policy. Would that be you or your spouse?"
, 1d. Select all that apply. River says they recently became insured through insurance offered at
their employer. River is the:
a. enrollee.
b. policyholder.
c. subscriber.
d. insured.
all of the above
2a. Review the following definitions and select the appropriate term for each.
a. Primary care provider who is responsible for supervising and coordinating healthcare
services: ____
b. Method of financing managed care, where providers accept pre-established payments for a
length of time: ___
c. Formal prior approval for an MCO for a patient to have a procedure done: ____
d. A request for a member to receive treatment from another provider: ____
a. gatekeeper
b. capitation
c. preauthorization
d. referral
2b. Review the following definitions and select the appropriate term for each.
a. A fee paid by the patient to the provider at the time of service: ___
b. Amount the insured must pay before insurance will provide coverage: ___
Medicaid, CHIP, TRICARE, CHAMPVA; Managed Care Systems (HMO, PPO, POS,
EPO); Reimbursement & Payment Methodologies (DRG, MS-DRG, APC, IPPS,
OPPS, SNF PPS, IRF PPS, LTCH PPS, HH PPS); Medical Billing, Coding &
Documentation (ICD, CPT, HCPCS, EHR, EMR, SOAP, MDS, OASIS, IRF PAI);
Healthcare Compliance & Legislation (HIPAA, COBRA, ERISA, HITECH, PPACA,
HCERA, MACRA, MIPPA); Cost-Sharing & Patient Financial Responsibility
(Deductible, Copayment, Coinsurance, Premiums); Utilization Review,
Preauthorization, Referrals, Risk Pools, Consumer-Driven Health Plans,
Accreditation, Quality Measures (HEDIS, NCQA, QISMC, EQRO); Physician Fee
Schedules & Case-Mix Index Exam Questions Verified and Provided with
Complete A+ Graded Rationales Latest Updated 2026
Welcome back to Dr. Erickson's office. In your position here, you communicate with patients
about their insurance benefits every day. You are responsible for obtaining accurate insurance
information from patients and explaining fees for their health care. As you review the following
scenarios, consider the importance of understanding basic health insurance terminology.
1a. A patient states, "I haven't met my deductible yet, and I'm afraid that this procedure will
cost a lot." What does the patient mean?
a. The patient doesn't have insurance.
b. The patient hasn't paid their copayment.
,c. The patient doesn't have the funds to pay for the procedure.
d. The patient hasn't paid the necessary amount for health care before the insurance company
will pay.
d. the patient hasn't paid the necessary amount for health care before the insurance company
will pay.
1b. You request a $30 copayment from the patient. The patient asks what a copayment is. What
do you say?
a. "A copayment is a percentage of the cost of the visit."
b. "A copayment is the total amount due for your visit."
c. "A copayment is a specific dollar amount you must pay for each visit or service received."
d. "A copayment is the amount our office charges for each visit."
Hide Feedback
c. "A copayment is a specific dollar amount you must pay for each visit or service received."
1c. A patient calls to schedule an appointment for themself. While obtaining their health
insurance information, you ask who the policyholder is. They state, "I'm not sure, my spouse or
me, I guess." What do you say next?
a. "The policyholder is the person that selected the health insurance policy. Would that be you
or your spouse?"
b. "The policyholder is the person who has signed a contract with the health insurance company
and owns the health insurance policy. Would that be you or your spouse?"
c. "The policyholder is the person who is receiving health care and who is covered by the health
insurance plan. I will list you as the policyholder."
d. "Thank you. I will list you both as the policyholder."
b. "The policyholder is the person who has signed a contract with the health insurance company
that owns the health insurance policy. Would that be you or your spouse?"
, 1d. Select all that apply. River says they recently became insured through insurance offered at
their employer. River is the:
a. enrollee.
b. policyholder.
c. subscriber.
d. insured.
all of the above
2a. Review the following definitions and select the appropriate term for each.
a. Primary care provider who is responsible for supervising and coordinating healthcare
services: ____
b. Method of financing managed care, where providers accept pre-established payments for a
length of time: ___
c. Formal prior approval for an MCO for a patient to have a procedure done: ____
d. A request for a member to receive treatment from another provider: ____
a. gatekeeper
b. capitation
c. preauthorization
d. referral
2b. Review the following definitions and select the appropriate term for each.
a. A fee paid by the patient to the provider at the time of service: ___
b. Amount the insured must pay before insurance will provide coverage: ___
