Financial Terminology in the Medical Field Quiz
Test your knowledge on medical insurance, billing, and financing with this quiz covering terms like co-payment, capitation, DRG, and more.
#1
What is a co-payment in medical insurance?
The total amount the insurance policy will cover
A fixed amount paid by a patient for covered services
The percentage of the bill not covered by insurance
A yearly payment required to keep the policy active
#2
What does the term 'out-of-pocket maximum' refer to in health insurance?
The maximum amount the insurance company will pay for covered services
The total amount a patient must pay for medication
The most a patient will have to pay for covered services in a plan year
The initial amount a patient must pay before insurance coverage begins
#3
What does 'fee-for-service' (FFS) mean in healthcare?
A prepaid healthcare service plan
A healthcare system where services are bundled into one fee
A payment model where services are unbundled and paid for separately
A flat rate payment for all healthcare services
#4
What is 'Medicare'?
A private health insurance program for the elderly
A state-provided healthcare service for low-income individuals
A federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease
A health savings account offered by employers
#5
What does 'Medicaid' cover?
Only emergency medical services for the uninsured
Healthcare services for individuals and families with low income and resources
Private healthcare services for elderly citizens
International healthcare services for travelers
#6
What is a 'deductible' in an insurance policy?
The amount paid out-of-pocket before an insurer pays any expenses
A refund given for lack of service use
A discount given to policyholders for healthy living
The premium paid for the insurance policy
#7
What does capitation mean in healthcare financing?
A method where providers are paid per procedure performed
A system where providers are paid for each patient enrolled over a period of time
The maximum amount an insurance company will pay for covered healthcare services
The total budget for healthcare services in a fiscal year
#8
What is DRG (Diagnosis-Related Group)?
A system to classify hospital cases into one of initially 467 groups
A detailed report of the patient's diagnosis and treatment
A group of diagnoses that are related to certain specialties
A medical guideline for diagnosis and management of diseases
#9
What is 'balance billing' in the context of healthcare services?
Sending a bill to the patient for the remaining balance after insurance payment
The practice of reviewing and adjusting medical bills for accuracy
Calculating the total cost of services before applying insurance
Balancing the budget of a healthcare facility
#10
What does 'prior authorization' in health insurance entail?
Authorization before a patient can file a complaint
Approval from an insurance company before receiving certain healthcare services
A preliminary health check before insurance coverage is granted
Authorization from a patient before their data can be shared
#11
In medical billing, what is an 'explanation of benefits' (EOB)?
A detailed breakdown of benefits provided by an insurance plan
A document that explains the medical procedures covered under a policy
A statement from an insurance company explaining what treatments and services were paid for
A guide provided to patients explaining how to claim their benefits
#12
What does 'coinsurance' mean in health insurance terms?
A fixed fee for services regardless of cost
The amount paid by the insurance company
A percentage of the cost that the insured pays after the deductible has been met
A bonus paid to insured individuals for not claiming
#13
What is the significance of the Resource-Based Relative Value Scale (RBRVS) in healthcare?
It is a scale used to measure the quality of resources provided by healthcare facilities.
It determines the prices for medical services based on the resources required to provide them.
It is a measure of patient satisfaction with healthcare services.
It ranks hospitals based on their financial stability.
#14
What is the primary goal of 'value-based care'?
To reduce healthcare costs by limiting unnecessary services
To improve patient outcomes by linking payments to the quality of care
To increase the volume of patients seen by healthcare providers
To standardize healthcare services across different providers
#15
What is 'risk adjustment' in health insurance?
Adjusting premiums based on the lifestyle risks of the insured
A financial adjustment applied to insurance premiums to reflect the health status of enrolled individuals
A method to balance the health insurance market
Reducing the risk of illness through preventative care incentives
#16
What is 'stop-loss insurance' in the context of health care?
Insurance for healthcare providers to cover losses from malpractice lawsuits
A type of reinsurance that provides protection for insurers against large claims
Insurance that stops coverage once a patient reaches a certain age
Health insurance that is terminated when the insured stops working
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