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

Question 2

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 3

If patients have large bills that they must pay over time, what can be set up for them?

Accepted Answer

A)  payment plan 
B)  tab 
C)  open account 
D)  financial spreadsheet 
A)  payment plan 
B)  tab 
C)  open account 
D)  financial spreadsheet

Question 4

Positive or negative corrections to a patient's account, such as returned check fees, are called ______________.

Accepted Answer

A)  charges 
B)  adjustments 
C)  capitation 
D)  payments 
A)  charges 
B)  adjustments 
C)  capitation 
D)  payments

Question 5

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 6

When are payments from the patient entered and the account updated?

Accepted Answer

A)  when they check in 
B)  during the visit 
C)  after the patient's visit 
D)  after they are balance billed 
A)  when they check in 
B)  during the visit 
C)  after the patient's visit 
D)  after they are balance billed

Question 7

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 8

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 9

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 10

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 11

The deductibles, coinsurance, and copayments patients pay are called their

Accepted Answer

A)  excluded services 
B)  out-of-pocket expenses 
C)  capitation rate 
D)  maximum benefit limit 
A)  excluded services 
B)  out-of-pocket expenses 
C)  capitation rate 
D)  maximum benefit limit

Question 12

Medical insurance plans require patients to pay for all services that are

Accepted Answer

A)  excluded 
B)  over-limit 
C)  both excluded and over-limit 
D)  hospital-related 
A)  excluded 
B)  over-limit 
C)  both excluded and over-limit 
D)  hospital-related

Question 13

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 14

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 15

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 
A)  real-time claims adjudication (RTC
A)  
B)  sliding fee schedule (SF) 
C)  service calculator 
D)  adjustable amount list

Question 16

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 17

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 18

Whether a physician participates in a plan or not is decided by

Accepted Answer

A)  the physician 
B)  the patient 
C)  the plan 
D)  the government 
A)  the physician 
B)  the patient 
C)  the plan 
D)  the government

Question 19

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 20

Which plan must meet a high deductible before the health plan can make a payment?

Accepted Answer

A)  preferred provider organization 
B)  point of service 
C)  health maintenance organization 
D)  consumer-driven health plan 
A)  preferred provider organization 
B)  point of service 
C)  health maintenance organization 
D)  consumer-driven health plan

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

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

If patients have large bills that they must pay over time, what can be set up for them?

Positive or negative corrections to a patient's account, such as returned check fees, are called ______________.

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

When are payments from the patient entered and the account updated?

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 does Real Time Claims Adjudication not generate?

Which is not a part of the RBRVS fee?

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

The deductibles, coinsurance, and copayments patients pay are called their

Medical insurance plans require patients to pay for all services that are

Who makes referral for patients in an HMO?

What are patients who do not have insurance coverage called?

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

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

The abbreviation CDHP stands for

Whether a physician participates in a plan or not is decided by

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

Which plan must meet a high deductible before the health plan can make a payment?

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 Payersblue Cross and Blue Shield

Medicare

Medicaid

Tricare and Champva

Workers Compensation and Automobiledisability 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?

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

If patients have large bills that they must pay over time, what can be set up for them?

Positive or negative corrections to a patient's account, such as returned check fees, are called ______________.

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

When are payments from the patient entered and the account updated?

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 does Real Time Claims Adjudication not generate?

Which is not a part of the RBRVS fee?

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

The deductibles, coinsurance, and copayments patients pay are called their

Medical insurance plans require patients to pay for all services that are

Who makes referral for patients in an HMO?

What are patients who do not have insurance coverage called?

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

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

The abbreviation CDHP stands for

Whether a physician participates in a plan or not is decided by

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

Which plan must meet a high deductible before the health plan can make a payment?

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 Payersblue Cross and Blue Shield

Medicare

Medicaid

Tricare and Champva

Workers Compensation and Automobiledisability Insurance

Claim Processing, Payments, and Collections

Hospital Insurance

Filters