front 1 What is the term that describes payment by someone other than the patient for services rendered? | back 1 Third-party reimbursement |
front 2 If a Medicare patient is being provided with a service that might not be covered, what should the office do? | back 2 Have the patient sign an ABN |
front 3 What are the components used to calculate the Medicare physician fee schedule | back 3 Practice expense, malpractice expense, and provider work |
front 4 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? | back 4 . Health reimbursement arrangement |
front 5 What is the government health plan that covers individuals who have a limited or low income | back 5 medicaid |
front 6 The percentage a patient pays for services after the deductible has been met is called: | back 6 coinsurance |
front 7 In a health maintenance organization (HMO), why is the PCP considered a "gatekeeper?" | back 7 Because the PCP must coordinate a patient's care and referral to a specialist |
front 8 What is the first step required to verify patient eligibility | back 8 The medical assistant determines if the insurance is a managed care plan |
front 9 What is the methodology of the resource-based relative value scale | back 9 To create the Medicare provider fee schedule |
front 10 Which of the following statements best describe utilization review? | back 10 A method of assessing the quality and appropriateness of the care provided to its members |
front 11 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? | back 11 c. The Affordable Care Act |
front 12 Blue Cross and Blue Shield health insurance plans are generally well-known examples of early years of: | back 12 commercial health insurance plans. |
front 13 What type of insurance plan typically has high deductibles and lower monthly premiums? | back 13 Consumer-driven health plans |
front 14 Medicare Part______was created to provide coverage for both generic and brand-name drugs. | back 14 D |
front 15 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 | back 15 Only 15 percent above the participating provider fee schedule amount for the service rendered |
front 16 What percent of the approved amount will Medicare pay after the deductible is satisfied | back 16 80 |
front 17 Which type of claim is automatically forwarded from Medicare to a secondary insurer after Medicare has paid its portion of a service? | back 17 Crossover claim |
front 18 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 | back 18 managed care |
front 19 part______ of Medicare is for hospital coverage, and any person who is receiving monthly Social Security benefits is automatically enrolled. | back 19 A |
front 20 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. | back 20 B |
front 21 part____is the segment of Medicare that enables beneficiaries to select a managed care plan as their primary coverage. | back 21 no data |