If a child is covered by both of her parents’ insurances and the total medical charges come to $365—$280 of which is covered by the primary insurance—how are the rest of the charges handled?

A claim is submitted to secondary insurance for $85

fixed payment made for each enrolled patient rather than reimbursement based on the type and number of services provided.

In the staff model HMO

the HMO has capitation contracts with provider groups.

a prepaid health insurance plan?

health maintenance organization (HMO)

the following steps must be taken to ensure coverage by a patient’s insurance company before the patient undergoes surgery to repair a rotator cuff?

precertifying the surgical procedure

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rma insuranve

insurance

Question	Answer
If a child is covered by both of her parents’ insurances and the total medical charges come to $365—$280 of which is covered by the primary insurance—how are the rest of the charges handled?	A claim is submitted to secondary insurance for $85
John Smith got an X-ray with Dr. Jones, a participating provider in Mr. Smith’s HMO. The allowed charge for an X-ray is $75, but Dr. Jones’s usual fee is $100. John Smith’s copayment due for each office visit is $15. How much can Dr. Jones get from Mr. S	$15
Capitation is	fixed payment made for each enrolled patient rather than reimbursement based on the type and number of services provided.
In the staff model HMO	the HMO has capitation contracts with provider groups.
Which of the following terms describes a statement indicating that a patient has agreed to pay for a service that is likely to be rejected by Medicare?	advance beneficiary notice
terms best describes a part of an insurance plan in which a specified dollar amount is paid to physicians based on each patient served, rather than by services performed?	copayment
The reimbursement system for Medicare Part A payments to hospitals is based on which of the following?	patient’s disease
insurance program that provides for the medically indigent?	Medicaid
a prepaid health insurance plan?	health maintenance organization (HMO)
the following steps must be taken to ensure coverage by a patient’s insurance company before the patient undergoes surgery to repair a rotator cuff?	precertifying the surgical procedure
based on a database of charges for a service to other patients by the same type of provider?	fee splitting
ICD codes that refer to factors that influence health status	V-codes
AOB	assignment of benefits
CPT symbol indicating description has been revised	triangle
insurance company is known as	carrier
method of controlling health care delivery by reviewing the appropriations of care before and after the care is provided is called	utilization review
upon receiving checks in the mail, the MA should first	restrictively endorse them

Created by: Ramos554692$

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