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Medical assisting re
chapter 13b
| Question | Answer |
|---|---|
| The range of fees charged by most physicians in a community is called | Customary Fee |
| If a child is covered by both patents insurances and there is a balance due,do you charge the patents parents the balance? | No, you would bill the secondary insurance |
| What is an example of fraud? | Altering a patient's chart to increase the amount reimbursed. |
| A participating provider in a managed health care program must write off | Disallowed charges |
| Which Medical program covers hospital charges | Part A |
| If Medicare sends a check for payment to the medical office, the physician is considered which one of the following parties? | Participating Provider |
| Who do you bill first if a patient is covered by both Medicare and Medicaid? | Medicare |
| The amount due from the patient for covered services from a participating provider is the difference between | The allowed charge and the patient's deductible and or coinsurance |
| What is the insurance that is designed to off set medical expenses resulting from prolonged injury or illness | Major Medical |
| What is the third party health plan that is funded by the federal government | TRICARE |
| What are some facts about Blue Cross and Blue Shield | It offers prepaid health services, and It follows a fee for service reimbursement plan |
| Capitation is | Fixed payment made for each enrolled patient rather than reimbursement based of the type and number or services provided. |
| Providers are required by law to file shich of the following for all eligible medicae patients | CMS-1500 |
| A nonparticipating provider's charge for a service is 65.00 and the allowed charge is 50.00.What is the amount due from the pt | 15.00 |
| The most common insurance claim form is the | HIFA-1500 |
| If a policy holder of an 80-20 plan was charged 3600, how much of this bill is the subscribers responsibility? | 720.00 |
| What is the authorization for the insurance company to make payments to the physician called | Assignment of benefits |
| The primary difference between and HMO and a PPO is that | HMO limits pts to providers that are contracted with the HOM, the PPO allows pt's to choose who they want to see but pay a higher deductible. HMO pts may select a specialist but PPO pts must get a referral. |
| TRICARE is not a health care benefit program for | Families of veterans with service related disabilities |
| Fee for service reimbursement is | Retroactive payment made after services are provided |
| In the point of service option | pts can see out of network providers for additional fees |
| In the group network model | The HMO has capitation contracts with providers groups |
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kimmykoolbeans