Health Insurance and Billing Concepts Quiz
Test your knowledge on health insurance terms such as premiums, deductibles, and out-of-pocket maximums with this healthcare billing quiz.
#1
What does the term 'premium' refer to in health insurance?
The amount paid for health services at the time of visit
The amount paid annually for health insurance coverage
The set amount you must pay before your insurance covers services
The network of healthcare providers under an insurance plan
#2
What is a 'deductible' in health insurance?
A fixed amount paid for a covered service after a premium
A premium reduction given for healthy habits
The amount you owe for health care services before your health insurance begins to pay
A type of insurance plan
#3
Which type of health insurance plan requires you to choose a primary care physician (PCP)?
Preferred Provider Organization (PPO)
Health Maintenance Organization (HMO)
Exclusive Provider Organization (EPO)
Point of Service (POS) plan
#4
Which term describes a network of healthcare providers that have agreed to lower their rates for plan members and meet quality standards?
Healthcare consortium
Preferred Provider Organization (PPO)
Provider network
Managed care organization
#5
What is the primary difference between 'in-network' and 'out-of-network' providers?
In-network providers offer services outside the coverage area, whereas out-of-network providers operate within it
In-network providers have a contract with the insurance company to provide services at a discounted rate, whereas out-of-network providers do not
Out-of-network providers are always specialists, whereas in-network providers are general practitioners
In-network providers require prior authorization for all services, whereas out-of-network providers do not
#6
What does 'out-of-pocket maximum' mean?
The most you have to pay for covered services in a plan year
The initial amount you pay before your insurance covers the rest
The total amount your insurance plan will pay for services
The annual premium for your health insurance
#7
What is 'coordination of benefits' in health insurance?
The process of determining the primary insurance when you have multiple health plans
Organizing your health benefits to cover medical expenses fully
A method to integrate benefits payments from your job with your health plan
Coordinating payment schedules between you and your insurance provider
#8
What is 'balance billing'?
The process of billing a patient for the difference between what their health insurance chooses to reimburse and what the provider chooses to charge
Creating a financial plan for a patient to pay off their medical bills
The act of sending a bill to both the insurance company and the patient simultaneously
Splitting the medical bill into manageable monthly payments
#9
What does 'prior authorization' mean in the context of health insurance?
The process of getting health insurance coverage approved for a prescription drug
Authorization required from a primary care physician before seeing a specialist
A prerequisite document needed before signing up for health insurance
Approval needed from an insurance company before receiving certain services or medications
#10
What is a 'formulary' in the context of health insurance?
A document that lists all covered medical procedures
A list of prescription drugs covered by a health insurance plan
The form used to apply for health insurance
A comprehensive list of healthcare providers in the network
#11
What is an 'Explanation of Benefits (EOB)'?
A bill from your healthcare provider
A document that outlines the costs covered by your insurance for a medical service
A detailed invoice for your monthly premium
A summary of your deductible contributions
#12
What does the term 'capitation' refer to in healthcare?
A cap on the annual amount a patient has to pay out-of-pocket
A payment arrangement for health care service providers such as physicians, clinics, and hospitals
The process of submitting and following up on claims with health insurance companies
A type of health insurance plan that provides comprehensive health services to members for a fixed, prepaid fee
#13
In health insurance, what is meant by 'tiered network'?
A classification system for hospitals based on their level of care
A health care provider system that ranks services from basic to premium
A network of providers categorized based on the cost of care and quality of service
A system where patients are moved through different levels of care depending on their health needs
#14
What is 'Utilization Management' in health insurance?
The management of how often health care facilities are used by patients
A set of policies for managing patient care and controlling the cost of that care
The process of evaluating the necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities
A system for managing the distribution of health care resources among patients
#15
Which act requires the provision of emergency medical treatment regardless of the patient's ability to pay?
The Health Insurance Portability and Accountability Act (HIPAA)
The Affordable Care Act (ACA)
The Emergency Medical Treatment and Active Labor Act (EMTALA)
The Patient Protection Act
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