The range of fees charged by most physicians in a community is called the
A Customary fee
B Reasonable fee
C Usual fee
E Average fee
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 parents are billed for 85
B A claim is submitted to secondary insurance for 85
C a claim is submitted to secondary insurance for 365
D the doctor writes off 85 and no one is charged
E a claim is submitted to secondary insurance for 280
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 disallowed charges
E amounts due from the carrier
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?
If a person is covered under both medicare and medicaid to which program should the claim be sent first?
C both should get it at the same time
D neither the pt gets billed
E neither claims are sent to an independent government agency
The amount due from the patient for a covered services froma a participating provider is the difference between?
A the allowed charge and the physicians fee
B the allowed charge and the patients deductible and/or coinsurance
C the physicians fee and coinsurance
D the physicians fee and deductable
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 basic medical
B hospital coverage
C disability protection
D libility insurance
E major medical
which of the following is a third party health plan that is funded by the federal government?
A 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
A payment at the time of service
B fixed prospective payment for services provided
C fixed payment made for each enrolled patient rather than reimbursment based on the type and number of services provided
D various payments for specific services
E a reduction in payment if services are not provided to a min number of patients
Providers are required by law to file which of the following for all eligible medicare patients?
If a nonparticipating providers charge for a service is 65 and the allowed charge is 50 the amount due from the patient?
The most common insurance claim form is the?
B charge sheet
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?
An authorization to the insurance company to make payments directly to the physician is called
A HCFA-1500 claim form
B assignment of benifits
D coordination of benifits
E service benefit plan
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 the coast guard
B national oceanic and atmospheric admin
C the navy
D families of uniformed personnel
E families of vererans with service related disabilities
Fee for service reimbursement is
A Retroactive payment made after services are provided
B fixed prospective payment for services provided during a specified time period
C Payment at time of service
D various payments for specific services provided during a time period
E fixed payjment made each month
A patients medical fees come to a total of 600 from a participating provider and the EOB lists the following info