CPB Practice EXAM B Top exam Questions and answers, 100% Accurate, rated A
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CPB Practice EXAM B Top exam Questions and answers, 100% Accurate, rated A
What is the term for the total amount of covered medical expenses a policyholder must pay each year out-of-pocket before the health insurance company begins to pay any benefits?
A. Copayment
B. Deductible
C. Secondar...
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CPB Practice EXAM B Top exam
Questions and answers, 100% Accurate,
rated A
What is the term for the total amount of covered medical expenses a policyholder must pay each year
out-of-pocket before the health insurance company begins to pay any benefits?
A. Copayment
B. Deductible
C. Secondary Payment
D. Coinsurance - ✔✔-A deductible is the amount a policyholder pays for health care services before the
health insurance begins to pay.
Which type of insurance covers physicians and other healthcare professionals for liability as to claims
arising from patient treatment?
A. Business liability
B. Bonding
C. Medical malpractice
D. Workers' compensation - ✔✔-Medical malpractice insurance is a type of liability insurance that
covers physicians and other healthcare professionals for liability as to claims arising from patient
treatment.
Which of the following does NOT fall under group policy insurance? I. The premium is paid for by the
employee. II. The premium is paid for (or partially paid for) by an employer. III. The employer selects the
plan(s) to offer to employees. IV. Physical exams and medical history questionnaires are a mandatory
part of the application process. V. V. Employee can make changes to the policy. VI. The employee's
spouse and children are not eligible for coverage.
A. III, IV, V
B. II - VI
C. II, IV, V
, D. I, IV, V, VI - ✔✔-Group health insurance coverage is a type of health policy that is purchased by an
employer and is offered to eligible employees of the company, and to eligible dependents of employees.
With group health insurance, the employer selects the plan (or plans) to offer to employees. With an
individual policy, you are the only one who can make changes to your policy and you are the only one
who can cancel the coverage. You have full control over your own policy. Applicants for individual health
insurance will need to complete a medical history questionnaire and have a physical exam when
applying for coverage.
Dr. Wallace is in a capitation contract with Belleview Managed Care Health Plan.He received $25,000
from the health plan to provide services for the 175 enrollees on the health plan. The services provided
by Dr. Wallace to the enrollees cost $23,000. Based on the information, what must be done?
A. Dr. Wallace can keep the $2,000 profit under the terms of the capitated plan.
B. Dr. Wallace experienced a loss under the capitated plan and will need to pay $2,000 to the health
plan.
C. Dr. Wallace will need to payout the $2,000 to the 175 enrollees.
D. Dr. Wallace is required to put the $2,000 in a mutual fund. - ✔✔-A capitated plan is where a provider
accepts a pre-established payment for providing healthcare services to enrollees in a health insurance
plan. It is a fixed, pre-arranged monthly payment received by a physician, clinic, or hospital per patient
enrolled in a health plan with a capitated contract. Monthly payment is calculated one year in advance
and remains fixed for that year, regardless of how often the patient needs services. If the provided
services cost less than the capitation amount, there is profit the provider can keep. If the services by the
provider to enrollees cost more than the capitation amount the physician loses money.
What is the deadline for filing a Medicare claim?
A. One year from the date of service
B. 30 days from the date of service
C. 90 days from the date of service
D. Two years from the date of service - ✔✔-Medicare claims must be filed no later than 12 months (or 1
full calendar year) after the date when the services were provided. If a claim isn't filed within this time
limit, Medicare can't pay its share. For example, if you see your doctor on February 1, 2017 the
Medicare claim for that visit must be filed no later than February, 1, 2018.
A provider sees a patient who has TRICARE Standard. The provider is not contracted with TRICARE but is
certified by the regional TRICARE Managed Care Support Contractor (MCSC). The provider charges $200
for the office visit. TRICARE allows $160 and pays $140. How much can the provider bill the patient for?
A. $0.00
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