What is the term that describes payment by someone other than the patient for services rendered?
Third-party reimbursement
If a Medicare patient is being provided with a service that might not be covered, what should the office do?
Have the patient sign an ABN
What are the components used to calculate the Medicare physician fee schedule
Practice expense, malpractice expense, and provider work
What is a consumer-driven health plan in which only the employer contributes, and the money is not lost at the end of the year called?
. Health reimbursement arrangement
What is the government health plan that covers individuals who have a limited or low income
medicaid
The percentage a patient pays for services after the deductible has been met is called:
coinsurance
In a health maintenance organization (HMO), why is the PCP considered a "gatekeeper?"
Because the PCP must coordinate a patient's care and referral to a specialist
What is the first step required to verify patient eligibility
The medical assistant determines if the insurance is a managed care plan
What is the methodology of the resource-based relative value scale
To create the Medicare provider fee schedule
Which of the following statements best describe utilization review?
A method of assessing the quality and appropriateness of the care provided to its members
What is the name of the legislation that passed in 2010 which mandates minimum coverage that must be offered by every health insurer and requires every American to purchase health insurance, or face fines, taxes, and penalties?
c. The Affordable Care Act
Blue Cross and Blue Shield health insurance plans are generally well-known examples of early years of:
commercial health insurance plans.
What type of insurance plan typically has high deductibles and lower monthly premiums?
Consumer-driven health plans
Medicare Part______was created to provide coverage for both generic and brand-name drugs.
D
Providers who sign a contract with Medicare to be a participating provider receive payment directly from Medicare for services rendered. Providers who choose not to be a participating provider can charge what amount of the Medicare participating provider fee schedule amount for the service rendered
Only 15 percent above the participating provider fee schedule amount for the service rendered
What percent of the approved amount will Medicare pay after the deductible is satisfied
80
Which type of claim is automatically forwarded from Medicare to a secondary insurer after Medicare has paid its portion of a service?
Crossover claim
Which of the following is a system of health care that integrates the delivery and payment of health care for covered persons by contracting with selected providers for comprehensive health care services at a reduced cost
managed care
part______ of Medicare is for hospital coverage, and any person who is receiving monthly Social Security benefits is automatically enrolled.
A
part_____of Medicare is for payment of other medical expenses, including office visits, X-ray and laboratory services, and the services of a provider in or out of the hospital.
B
part____is the segment of Medicare that enables beneficiaries to select a managed care plan as their primary coverage.
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