The range of fees charged by most physicians in a community is called theA Usual feeB Customary feeC Average feeD PremiumE Reasonable fee
B
If a child is covered by both of her parents insurance and the total medical charges come to 365, 280 of which is covered by the primary insurance how are the rest of the charges handled?A the doctor writes off 85 and no one is chargedB A claim is submitted to secondary insurance for 85C The parents are billed for 85D a claim is submitted to secondary insurance for 280E a claim is submitted to secondary insurance for 365
B
Which of the following is an example of fraud?A miscoding a dx unintentionalyB leaving a field blank on the CMS-1500 by mistakeC altering a patients chart to increase the amount reimbursedD all of the above
C
A participating provider in a managed healthcare program must write offA disallowed chargesB deductiblesC amounts due from the carrierD coinsuranceE copayments
A
Which of the following medicare programs covers hospital charges?A Part AB Part BC Part CD Both part A and BE none of the above
A
If medicare sends a check for payment to the medical office, the physician is considered which one of the following parties?A eligibleB sponsoringC registeredD acceptingE Participating
E
If a person is covered under both medicare and medicaid to which program should the claim be sent first?A neither claims are sent to an independent government agencyB neither the pt gets billedC medicaidD medicareE both should get it at the same time
D
The amount due from the patient for a covered services froma a participating provider is the difference between?A the allowed charge and the patients deductible and/or coinsuranceB the allowed charge and the physicians feeC the physicians fee and deductableD the physicians fee and coinsuranceE the physicians fee and the capitation
A
which of the following types of medical insureance is designed to offset medical expenses resulting from prolonged injury or illnessA libility insuranceB disability protectionC hospital coverageD major medicalE basic medical
D
which of the following is a third party health plan that is funded by the federal government?A starmarkB blue cross and blue shieldC aetnaD physicians mutualE TRICARE
E
which of the following is true about blue cross and blue shield?A it offers prepaid health servicesB it helps medicare to determine covered health servicesC it follows a fee for service reimbursement planD both a and CE All of the above
D
Capitation isA fixed payment made for each enrolled patient rather than reimbursment based on the type and number of services providedB a reduction in payment if services are not provided to a min number of patientsC various payments for specific servicesD fixed prospective payment for services providedE payment at the time of service
A
Providers are required by law to file which of the following for all eligible medicare patients?A CMSB CMS-1500C ICD-9D RBRVSE HCPCS
B
If a nonparticipating providers charge for a service is 65 and the allowed charge is 50 the amount due from the patient?A 65B 10C 15D 115E 50
C
The most common insurance claim form is the?A superbillB charge sheetC CMS-1500D ICD-9E none of the above
C
If a policy holder of an 80:20 plan had foot surgery that cost 3,600, how much of this bill is the subscriber responsible to pay?A 180B 720C 2880D 450E 3600
B
An authorization to the insurance company to make payments directly to the physician is calledA assignment of benifitsB trackerC service benefit planD coordination of benifitsE HCFA-1500 claim form
A
The primary difference between an HMO and a PPO is that
An HMO locks patients into receiving services from providers with whom it has contracts whereas a PPO allows patients to choose in return for higher deductibles and copayments
TRICARE is a health care benefit program for all of the following EXCEPT?A families of vererans with service related disabilitiesB families of uniformed personnelC national oceanic and atmospheric adminD the coast guardE the navy
A
Fee for service reimbursement isA fixed payjment made each monthB Retroactive payment made after services are providedC Payment at time of serviceD various payments for specific services provided during a time periodE fixed prospective payment for services provided during a specified time period
B
A patients medical fees come to a total of 600 from a participating provider and the EOB lists the following info
$12