Question 1

Which should be paid at the time of service?

Accepted Answer

A)  previous balances 
B)  balances from other family members 
C)  coinsurance 
D)  transaction fees

Question 2

Out-of-pocket medical expenses are paid by the

Accepted Answer

A)  provider 
B)  physician 
C)  patient 
D)  health plan

Question 3

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

Question 4

At what point in the billing process might a physician practice decide to have a policy to collect patients' payments?

Accepted Answer

A)  claims processing 
B)  adjudication 
C)  both claims processing and adjudication 
D)  neither claims processing nor adjudication

Question 5

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

Question 6

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

Question 7

Which of the following do not usually file claims for patients?

Accepted Answer

A)  PCP 
B)  non-participating physicians 
C)  health plans 
D)  hospitals

Question 8

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

Question 9

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

Question 10

To estimate charges the patient will pay, the medical assistant verifies:

Accepted Answer

A)  UCR 
B)  deductible amount 
C)  discounted rate 
D)  adjustable amount

Question 11

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

Question 12

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

Question 13

Before the payer begins to pay benefits, what must a policyholder pay annually under a typical indemnity plan?

Accepted Answer

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

Question 14

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

Question 15

In order, what are the next steps in the billing cycle after the patient checks out?

Accepted Answer

A)  there is no particular order 
B)  patient is billed what they owe, send claim to insurance, and get reimbursement 
C)  refer to a specialist, make next appointment, and file away the chart 
D)  file claim, insurance payment, and patient billed for what they owe

Question 16

Which answer correctly lists the main methods(s) payers use to pay providers?

Accepted Answer

A)  allowed charges 
B)  allowed charges, contracted fee schedule, and capitation 
C)  contracted fee schedule and capitation 
D)  capitation and retrospective payments

Question 17

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

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

Question 19

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

Question 20

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

Exam 6: Payment Methods and Checkout Procedures