Question 1

What is one way a practice can help patients determine what they may owe?

Accepted Answer

A)  previous patients can be used as a guideline 
B)  swipe card reader 
C)  there is no way to determine 
D)  the patient will know since it is their responsibility 
A)  previous patients can be used as a guideline 
B)  swipe card reader 
C)  there is no way to determine 
D)  the patient will know since it is their responsibility B

Question 2

Which of the following is not a typical time-of-service payment?

Accepted Answer

A)  over-the-limit services 
B)  self-pay charges 
C)  registration fees 
D)  supplies and other services 
A)  over-the-limit services 
B)  self-pay charges 
C)  registration fees 
D)  supplies and other services C

Question 3

What document can the patient use to report the charges and payments to the insurance company?

Accepted Answer

A)  explanation of benefits 
B)  encounter form 
C)  walkout receipt 
D)  superbill 
A)  explanation of benefits 
B)  encounter form 
C)  walkout receipt 
D)  superbill C

Question 4

An option in an HMO that allows patients to use non-HMO providers is called

Accepted Answer

A)  a preferred provider option 
B)  a point-of-service option 
C)  a physician-hospital option 
D)  a managed care option 
A)  a preferred provider option 
B)  a point-of-service option 
C)  a physician-hospital option 
D)  a managed care option

Question 5

A capitation payment covers the services for a health plan member for

Accepted Answer

A)  a visit to the office 
B)  the duration of their relationship 
C)  an unspecified period of time 
D)  a specific period of time 
A)  a visit to the office 
B)  the duration of their relationship 
C)  an unspecified period of time 
D)  a specific period of time

Question 6

What does Real Time Claims Adjudication not generate?

Accepted Answer

A)  "real-time" payment 
B)  patient financial responsibility 
C)  explanation of benefits 
D)  claim errors 
A)  "real-time" payment 
B)  patient financial responsibility 
C)  explanation of benefits 
D)  claim errors

Question 7

The Centers for Medicare and Medicaid Services (CMS) Resource-Based Relative Value Scale (RBRVS) builds on the RVS method by adding factors for

Accepted Answer

A)  patient expenses 
B)  hospital visits 
C)  health plan costs 
D)  provider expenses 
A)  patient expenses 
B)  hospital visits 
C)  health plan costs 
D)  provider expenses

Question 8

All of the following procedures are completed at the end of a patient visit, except:

Accepted Answer

A)  charges are calculated 
B)  payments are entered 
C)  case information is posted 
D)  insurance is verified 
A)  charges are calculated 
B)  payments are entered 
C)  case information is posted 
D)  insurance is verified

Question 9

Discounted fee-for-service arrangements are also known as

Accepted Answer

A)  capitation 
B)  the allowed amount 
C)  contracted fee schedules 
D)  None of these 
A)  capitation 
B)  the allowed amount 
C)  contracted fee schedules 
D)  None of these

Question 10

What should explain what is required of the patient financially when payment is due?

Accepted Answer

A)  contract 
B)  financial policy 
C)  explanation of benefits 
D)  fee slip 
A)  contract 
B)  financial policy 
C)  explanation of benefits 
D)  fee slip

Question 11

The first step in calculating RBRVS is to determine the ____________.

Accepted Answer

A)  diagnosis codes 
B)  HCPCS codes 
C)  UCR codes 
D)  procedure codes 
A)  diagnosis codes 
B)  HCPCS codes 
C)  UCR codes 
D)  procedure codes

Question 12

A PPO plan will pay lower benefits if a patient sees a provider who is

Accepted Answer

A)  in the network 
B)  out-of-network 
C)  both in the network and out-of-network 
D)  neither in the network nor out-of-network 
A)  in the network 
B)  out-of-network 
C)  both in the network and out-of-network 
D)  neither in the network nor out-of-network

Question 13

Under most managed care plans, what must patients pay to the provider at the time of service?

Accepted Answer

A)  copayment 
B)  write off 
C)  deductible 
D)  coinsurance 
A)  copayment 
B)  write off 
C)  deductible 
D)  coinsurance

Question 14

What summarizes the services and charges for that day as well as any payment the patient made?

Accepted Answer

A)  encounter summary 
B)  walkout receipt 
C)  superbill 
D)  fee slip 
A)  encounter summary 
B)  walkout receipt 
C)  superbill 
D)  fee slip

Question 15

What is not a part of the real-time claims adjudication (RTCA)?

Accepted Answer

A)  create the claim 
B)  note errors on the claim 
C)  receive real-time payment 
D)  receive real-time responses from payer 
A)  create the claim 
B)  note errors on the claim 
C)  receive real-time payment 
D)  receive real-time responses from payer

Question 16

Which method does Medicare use to pay physicians in group practices?

Accepted Answer

A)  Diagnosis-Related Group (DRG) 
B)  Usual, Customary, and Reasonable (UCR) 
C)  Resource-based relative value scale (RBRVS) 
D)  Relative Value Units (RVU) 
A)  Diagnosis-Related Group (DRG) 
B)  Usual, Customary, and Reasonable (UCR) 
C)  Resource-based relative value scale (RBRVS) 
D)  Relative Value Units (RVU)

Question 17

What is the tool for calculating charges due at the time of service?

Accepted Answer

A)  real-time claims adjudication (RTC
A)  
B)  sliding fee schedule (SF) 
C)  service calculator 
D)  adjustable amount list The ideal tool for calculating charges due at the time of service is called real-time claims adjudication (RTC
A) . 
A)  real-time claims adjudication (RTC
A)  
B)  sliding fee schedule (SF) 
C)  service calculator 
D)  adjustable amount list The ideal tool for calculating charges due at the time of service is called real-time claims adjudication (RTC
A) .

Question 18

In what situation is the patient offered a walkout receipt?

Accepted Answer

A)  a managed care patient has seen the doctor 
B)  the patient has made a payment at the end of a visit 
C)  a clearinghouse has sent a payment 
D)  the account balance has been written off completely 
A)  a managed care patient has seen the doctor 
B)  the patient has made a payment at the end of a visit 
C)  a clearinghouse has sent a payment 
D)  the account balance has been written off completely

Question 19

If the participating provider's charge is higher than the allowed amount, which amount is the basis for reimbursement?

Accepted Answer

A)  allowed amount 
B)  copayment 
C)  deductible 
D)  customary amount 
A)  allowed amount 
B)  copayment 
C)  deductible 
D)  customary amount

Question 20

If a practice has not accepted assignment, and collects payment from the patient at the time of service and then sends a claim to the plan on behalf of the patient, what should the patient expect as the next course of action?

Accepted Answer

A)  receive a bill for the remainder 
B)  receive a reimbursement check from the insurance company 
C)  if a practice has not accepted assignment, they wouldn't be able to send a claim 
D)  if a practice has not accepted assignment, they wouldn't be able to see the patient 
A)  receive a bill for the remainder 
B)  receive a reimbursement check from the insurance company 
C)  if a practice has not accepted assignment, they wouldn't be able to send a claim 
D)  if a practice has not accepted assignment, they wouldn't be able to see the patient

What is one way a practice can help patients determine what they may owe?

Which of the following is not a typical time-of-service payment?

What document can the patient use to report the charges and payments to the insurance company?

An option in an HMO that allows patients to use non-HMO providers is called

A capitation payment covers the services for a health plan member for

What does Real Time Claims Adjudication not generate?

The Centers for Medicare and Medicaid Services (CMS) Resource-Based Relative Value Scale (RBRVS) builds on the RVS method by adding factors for

All of the following procedures are completed at the end of a patient visit, except:

Discounted fee-for-service arrangements are also known as

What should explain what is required of the patient financially when payment is due?

The first step in calculating RBRVS is to determine the ____________.

A PPO plan will pay lower benefits if a patient sees a provider who is

Under most managed care plans, what must patients pay to the provider at the time of service?

What summarizes the services and charges for that day as well as any payment the patient made?

What is not a part of the real-time claims adjudication (RTCA)?

Which method does Medicare use to pay physicians in group practices?

What is the tool for calculating charges due at the time of service?

In what situation is the patient offered a walkout receipt?

If the participating provider's charge is higher than the allowed amount, which amount is the basis for reimbursement?

If a practice has not accepted assignment, and collects payment from the patient at the time of service and then sends a claim to the plan on behalf of the patient, what should the patient expect as the next course of action?

From Patient to Payment Understanding Medical Insurance

Electronic Health Records, HIPAA, and Hitech: Sharing and Protectin

Patient Encounters and Billing Information

Diagnostic Coding

Procedural Coding

Health Care Claim Preparation and Transmission

Private Payers/Blue Cross and Blue Shield

Medicare

Medicaid

Tricare and Champva

Workers Compensation and Automobile/Disability Insurance

Claim Processing, Payments, and Collections

Hospital Insurance

Filters

Exam 6: Payment Methods and Checkout Procedures

What is one way a practice can help patients determine what they may owe?

Which of the following is not a typical time-of-service payment?

What document can the patient use to report the charges and payments to the insurance company?

An option in an HMO that allows patients to use non-HMO providers is called

A capitation payment covers the services for a health plan member for

What does Real Time Claims Adjudication not generate?

The Centers for Medicare and Medicaid Services (CMS) Resource-Based Relative Value Scale (RBRVS) builds on the RVS method by adding factors for

All of the following procedures are completed at the end of a patient visit, except:

Discounted fee-for-service arrangements are also known as

What should explain what is required of the patient financially when payment is due?

The first step in calculating RBRVS is to determine the ____________.

A PPO plan will pay lower benefits if a patient sees a provider who is

Under most managed care plans, what must patients pay to the provider at the time of service?

What summarizes the services and charges for that day as well as any payment the patient made?

What is not a part of the real-time claims adjudication (RTCA)?

Which method does Medicare use to pay physicians in group practices?

What is the tool for calculating charges due at the time of service?

In what situation is the patient offered a walkout receipt?

If the participating provider's charge is higher than the allowed amount, which amount is the basis for reimbursement?

If a practice has not accepted assignment, and collects payment from the patient at the time of service and then sends a claim to the plan on behalf of the patient, what should the patient expect as the next course of action?

From Patient to Payment Understanding Medical Insurance

Electronic Health Records, HIPAA, and Hitech: Sharing and Protectin

Patient Encounters and Billing Information

Diagnostic Coding

Procedural Coding

Health Care Claim Preparation and Transmission

Private Payers/Blue Cross and Blue Shield

Medicare

Medicaid

Tricare and Champva

Workers Compensation and Automobile/Disability Insurance

Claim Processing, Payments, and Collections

Hospital Insurance

Filters