Question 1

If a patient makes a payment at the time of service, a medical billing program is used to print a(n)

Accepted Answer

A)  invoice 
B)  walkout receipt 
C)  statement 
D)  superbill 
A)  invoice 
B)  walkout receipt 
C)  statement 
D)  superbill

Question 2

The abbreviation CDHP stands for

Accepted Answer

A)  consumer-driven health plan 
B)  company-driven health plan 
C)  coinsurance-driven health plan 
D)  copayment-driven health plan 
A)  consumer-driven health plan 
B)  company-driven health plan 
C)  coinsurance-driven health plan 
D)  copayment-driven health plan

Question 3

Numerical values are assigned to medical services, based on nationwide research, in a(n)

Accepted Answer

A)  relative value scale (RVS) 
B)  fee schedule 
C)  preferred-provider organization (PPO) 
D)  usual, customary, and reasonable (UCR) 
A)  relative value scale (RVS) 
B)  fee schedule 
C)  preferred-provider organization (PPO) 
D)  usual, customary, and reasonable (UCR)

Question 4

For which type of insurance plan would the medical assistant verify the patient's deductible, the coverage benefits and the coinsurance or other financial information?

Accepted Answer

A)  capitated plan 
B)  high deductible plan 
C)  managed care plan 
D)  None of these 
A)  capitated plan 
B)  high deductible plan 
C)  managed care plan 
D)  None of these

Question 5

If the provider's charge is lower than the allowed amount, the reimbursement is based on

Accepted Answer

A)  the amount billed 
B)  the amount allowed 
C)  the difference 
D)  a percentage 
A)  the amount billed 
B)  the amount allowed 
C)  the difference 
D)  a percentage

Question 6

What does the Real-Time Claims Adjudication tool not provide?

Accepted Answer

A)  exact payment due 
B)  errors on the claim 
C)  how much of the deductible the patient has met 
D)  patient's financial responsibility 
A)  exact payment due 
B)  errors on the claim 
C)  how much of the deductible the patient has met 
D)  patient's financial responsibility

Question 7

Who makes referral for patients in an HMO?

Accepted Answer

A)  the gatekeeper 
B)  the primary care physician 
C)  the specialist 
D)  both the gatekeeper and the primary care physician 
A)  the gatekeeper 
B)  the primary care physician 
C)  the specialist 
D)  both the gatekeeper and the primary care physician

Question 8

Which is not a part of the RBRVS fee?

Accepted Answer

A)  RVU 
B)  GCPI 
C)  nationally uniform conversion factor 
D)  UCR 
A)  RVU 
B)  GCPI 
C)  nationally uniform conversion factor 
D)  UCR

Question 9

A list of charges for the procedures and services a physician performs is a

Accepted Answer

A)  fee schedule 
B)  health plan 
C)  payment list 
D)  charge list 
A)  fee schedule 
B)  health plan 
C)  payment list 
D)  charge list

Question 10

Collecting the difference between a provider's usual fee and a payer's lower allowed charge from the insured is called

Accepted Answer

A)  claims processing 
B)  balance billing 
C)  collections 
D)  payment billing 
A)  claims processing 
B)  balance billing 
C)  collections 
D)  payment billing

Question 11

Which health plan has a rule that prohibits physicians from obtaining any patient payment except a copayment until after the claim is paid?

Accepted Answer

A)  HMO 
B)  PPO 
C)  Medicaid 
D)  Medicare 
A)  HMO 
B)  PPO 
C)  Medicaid 
D)  Medicare

Question 12

What must be met before benefits from a payer begin?

Accepted Answer

A)  deductible 
B)  health maintenance organization 
C)  fee schedule 
D)  coinsurance 
A)  deductible 
B)  health maintenance organization 
C)  fee schedule 
D)  coinsurance

Question 13

When is a capitated payment made to a provider?

Accepted Answer

A)  after services are given 
B)  before services are given 
C)  if the original payment is rejected 
D)  it is not given at all 
A)  after services are given 
B)  before services are given 
C)  if the original payment is rejected 
D)  it is not given at all

Question 14

After checkout, what is a next step in the billing cycle?

Accepted Answer

A)  filing of charts 
B)  send claim for insurance payments 
C)  refer to a specialist 
D)  make next appointment 
A)  filing of charts 
B)  send claim for insurance payments 
C)  refer to a specialist 
D)  make next appointment

Question 15

What might a contract between a health plan and a provider entail?

Accepted Answer

A)  to prohibit balance billing 
B)  amount of visits a patient can incur 
C)  to prohibit all payment until after a claim is paid 
D)  a limited amount of referrals 
A)  to prohibit balance billing 
B)  amount of visits a patient can incur 
C)  to prohibit all payment until after a claim is paid 
D)  a limited amount of referrals

Question 16

The comparison of the usual fee and individual physician charges for a service, the customary fee charged by most physicians in the community, and the reasonable fee for service is known as what approach?

Accepted Answer

A)  usual, customary, and reasonable (UCR) 
B)  Resource-Based Relative Value Scale (RBRVS) 
C)  relative value scale (RVS) 
D)  None of these 
A)  usual, customary, and reasonable (UCR) 
B)  Resource-Based Relative Value Scale (RBRVS) 
C)  relative value scale (RVS) 
D)  None of these

Question 17

What are patients who do not have insurance coverage called?

Accepted Answer

A)  indigent 
B)  self-pay 
C)  charity 
D)  write offs 
A)  indigent 
B)  self-pay 
C)  charity 
D)  write offs

Question 18

What might a health plan require if the patient has more than one covered service in a single day?

Accepted Answer

A)  bundled payment 
B)  write off 
C)  discounted rate 
D)  multiple copayments 
A)  bundled payment 
B)  write off 
C)  discounted rate 
D)  multiple copayments

Question 19

What does it mean when a provider accepts assignment?

Accepted Answer

A)  that they must collect payment and send a claim afterwards 
B)  that they do not bill the patient until a claim is processed 
C)  to accept the allowed charge as full payment 
D)  to accept patients of a particular health plan 
A)  that they must collect payment and send a claim afterwards 
B)  that they do not bill the patient until a claim is processed 
C)  to accept the allowed charge as full payment 
D)  to accept patients of a particular health plan

Question 20

What is the goal of an effective patient checkout procedure?

Accepted Answer

A)  the patient does not get aggravated over charges 
B)  the payment plan is set up according to UCR 
C)  the patient understands financial responsibility 
D)  to have the patient refer friends and family 
A)  the patient does not get aggravated over charges 
B)  the payment plan is set up according to UCR 
C)  the patient understands financial responsibility 
D)  to have the patient refer friends and family

If a patient makes a payment at the time of service, a medical billing program is used to print a(n)

The abbreviation CDHP stands for

Numerical values are assigned to medical services, based on nationwide research, in a(n)

For which type of insurance plan would the medical assistant verify the patient's deductible, the coverage benefits and the coinsurance or other financial information?

If the provider's charge is lower than the allowed amount, the reimbursement is based on

What does the Real-Time Claims Adjudication tool not provide?

Who makes referral for patients in an HMO?

Which is not a part of the RBRVS fee?

A list of charges for the procedures and services a physician performs is a

Collecting the difference between a provider's usual fee and a payer's lower allowed charge from the insured is called

Which health plan has a rule that prohibits physicians from obtaining any patient payment except a copayment until after the claim is paid?

What must be met before benefits from a payer begin?

When is a capitated payment made to a provider?

After checkout, what is a next step in the billing cycle?

What might a contract between a health plan and a provider entail?

The comparison of the usual fee and individual physician charges for a service, the customary fee charged by most physicians in the community, and the reasonable fee for service is known as what approach?

What are patients who do not have insurance coverage called?

What might a health plan require if the patient has more than one covered service in a single day?

What does it mean when a provider accepts assignment?

What is the goal of an effective patient checkout procedure?

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

If a patient makes a payment at the time of service, a medical billing program is used to print a(n)

The abbreviation CDHP stands for

Numerical values are assigned to medical services, based on nationwide research, in a(n)

For which type of insurance plan would the medical assistant verify the patient's deductible, the coverage benefits and the coinsurance or other financial information?

If the provider's charge is lower than the allowed amount, the reimbursement is based on

What does the Real-Time Claims Adjudication tool not provide?

Who makes referral for patients in an HMO?

Which is not a part of the RBRVS fee?

A list of charges for the procedures and services a physician performs is a

Collecting the difference between a provider's usual fee and a payer's lower allowed charge from the insured is called

Which health plan has a rule that prohibits physicians from obtaining any patient payment except a copayment until after the claim is paid?

What must be met before benefits from a payer begin?

When is a capitated payment made to a provider?

After checkout, what is a next step in the billing cycle?

What might a contract between a health plan and a provider entail?

The comparison of the usual fee and individual physician charges for a service, the customary fee charged by most physicians in the community, and the reasonable fee for service is known as what approach?

What are patients who do not have insurance coverage called?

What might a health plan require if the patient has more than one covered service in a single day?

What does it mean when a provider accepts assignment?

What is the goal of an effective patient checkout procedure?

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