Question 1

Which of the following is not a component of a network created by a PPO?

Accepted Answer

A)  physicians 
B)  patients 
C)  hospitals 
D)  other health care providers 
A)  physicians 
B)  patients 
C)  hospitals 
D)  other health care providers

Question 2

What term describes a physician who does not participate in a particular plan?

Accepted Answer

A)  Non-PAR 
B)  PAR 
C)  non-allowed 
D)  out-of-PAR 
A)  Non-PAR 
B)  PAR 
C)  non-allowed 
D)  out-of-PAR

Question 3

What percentage of the allowed charge is the patient responsible for through the Original Medicare plan after the patient meets their annual deductible?

Accepted Answer

A)  10% 
B)  20% 
C)  50% 
D)  80% 
A)  10% 
B)  20% 
C)  50% 
D)  80%

Question 4

Which of the following is not taken into account when determining resource-based fee structures?

Accepted Answer

A)  how many credentials the physician performing the procedure has 
B)  the relative risk that the procedure presents to the patient 
C)  how difficult it is for the provider to do the procedure 
D)  how much office overhead the procedure involves 
A)  how many credentials the physician performing the procedure has 
B)  the relative risk that the procedure presents to the patient 
C)  how difficult it is for the provider to do the procedure 
D)  how much office overhead the procedure involves

Question 5

If a participating provider's usual charge is higher than the allowed amount, and balance billing is not permitted, what should the difference between the two charges become?

Accepted Answer

A)  a write off 
B)  a deductible 
C)  a subtraction 
D)  a deduction 
A)  a write off 
B)  a deductible 
C)  a subtraction 
D)  a deduction

Question 6

What percentage of the allowed charge does Medicare Part B Original Plan cover after the patient meets their annual deductible?

Accepted Answer

A)  10% 
B)  20% 
C)  50% 
D)  80% 
A)  10% 
B)  20% 
C)  50% 
D)  80%

Question 7

A preauthorization form is typically used with which type of transactions?

Accepted Answer

A)  cash 
B)  check 
C)  credit card 
D)  wire transfer 
A)  cash 
B)  check 
C)  credit card 
D)  wire transfer

Question 8

Within a managed care organization, the gatekeeper is another name for a

Accepted Answer

A)  health plan 
B)  primary care physician 
C)  provider 
D)  private plan 
A)  health plan 
B)  primary care physician 
C)  provider 
D)  private plan

Question 9

Under a point-of-service (POS) plan, an HMO patient who does not want to be limited to network providers might have to make

Accepted Answer

A)  larger payments 
B)  out-of-state visits 
C)  hospital visits 
D)  None of these 
A)  larger payments 
B)  out-of-state visits 
C)  hospital visits 
D)  None of these

Which of the following is not a component of a network created by a PPO?

What term describes a physician who does not participate in a particular plan?

What percentage of the allowed charge is the patient responsible for through the Original Medicare plan after the patient meets their annual deductible?

Which of the following is not taken into account when determining resource-based fee structures?

If a participating provider's usual charge is higher than the allowed amount, and balance billing is not permitted, what should the difference between the two charges become?

What percentage of the allowed charge does Medicare Part B Original Plan cover after the patient meets their annual deductible?

A preauthorization form is typically used with which type of transactions?

Within a managed care organization, the gatekeeper is another name for a

Under a point-of-service (POS) plan, an HMO patient who does not want to be limited to network providers might have to make

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

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Exam 6: Payment Methods and Checkout Procedures

Which of the following is not a component of a network created by a PPO?

What term describes a physician who does not participate in a particular plan?

What percentage of the allowed charge is the patient responsible for through the Original Medicare plan after the patient meets their annual deductible?

Which of the following is not taken into account when determining resource-based fee structures?

If a participating provider's usual charge is higher than the allowed amount, and balance billing is not permitted, what should the difference between the two charges become?

What percentage of the allowed charge does Medicare Part B Original Plan cover after the patient meets their annual deductible?

A preauthorization form is typically used with which type of transactions?

Within a managed care organization, the gatekeeper is another name for a

Under a point-of-service (POS) plan, an HMO patient who does not want to be limited to network providers might have to make

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