RMA 13

The range of fees charged by most physicians in a community is called the

A Customary fee
B Usual fee
C Reasonable fee
D Average fee
E Premium

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 a claim is submitted to secondary insurance for 365
B the doctor writes off 85 and no one is charged
C The parents are billed for 85
D a claim is submitted to secondary insurance for 280
E A claim is submitted to secondary insurance for 85

Which of the following is an example of fraud?

A miscoding a dx unintentionaly
B leaving a field blank on the CMS-1500 by mistake
C altering a patients chart to increase the amount reimbursed
D all of the above

A participating provider in a managed healthcare program must write off

A coinsurance
B deductibles
C disallowed charges
D amounts due from the carrier
E copayments

Which of the following medicare programs covers hospital charges?

A Part A
B Part B
C Part C
D Both part A and B
E none of the above

If medicare sends a check for payment to the medical office, the physician is considered which one of the following parties?

A sponsoring
B accepting
C Participating
D eligible
E registered

If a person is covered under both medicare and medicaid to which program should the claim be sent first?

A neither the pt gets billed
B medicare
C both should get it at the same time
D neither claims are sent to an independent government agency
E medicaid

The amount due from the patient for a covered services froma a participating provider is the difference between?

A the physicians fee and deductable
B the allowed charge and the physicians fee
C the allowed charge and the patients deductible and/or coinsurance
D the physicians fee and coinsurance
E the physicians fee and the capitation

which of the following types of medical insureance is designed to offset medical expenses resulting from prolonged injury or illness

A major medical
B disability protection
C basic medical
D hospital coverage
E libility insurance

which of the following is a third party health plan that is funded by the federal government?

A aetna
B starmark
C TRICARE
D blue cross and blue shield
E physicians mutual

which of the following is true about blue cross and blue shield?

A it offers prepaid health services
B it helps medicare to determine covered health services
C it follows a fee for service reimbursement plan
D both a and C
E All of the above

Capitation is

A fixed payment made for each enrolled patient rather than reimbursment based on the type and number of services provided
B fixed prospective payment for services provided
C a reduction in payment if services are not provided to a min number of patients
D payment at the time of service
E various payments for specific services

Providers are required by law to file which of the following for all eligible medicare patients?

A HCPCS
B RBRVS
C ICD-9
D CMS-1500
E CMS

If a nonparticipating providers charge for a service is 65 and the allowed charge is 50 the amount due from the patient?

A 10
B 15
C 50
D 65
E 115

The most common insurance claim form is the?

A superbill
B charge sheet
C CMS-1500
D ICD-9
E none of the above

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 720
B 180
C 450
D 2880
E 3600

An authorization to the insurance company to make payments directly to the physician is called

A service benefit plan
B HCFA-1500 claim form
C coordination of benifits
D tracker
E assignment of benifits

The primary difference between an HMO and a PPO is that

TRICARE is a health care benefit program for all of the following EXCEPT?

A national oceanic and atmospheric admin
B families of vererans with service related disabilities
C the coast guard
D families of uniformed personnel
E the navy

Fee for service reimbursement is

A fixed payjment made each month
B various payments for specific services provided during a time period
C fixed prospective payment for services provided during a specified time period
D Retroactive payment made after services are provided
E Payment at time of service

A patients medical fees come to a total of 600 from a participating provider and the EOB lists the following info