Chap 11/12
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| show | Limits the patient's choice of a personal physician (PCP)
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| show | Capitation
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| show | Foundation for medical care.
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| In an Independant Practise Association (IPA), phyicians are? a. paid salaries by the practise association. b. not employees and are not paid salaries, c. paid salaries by their own independent group. d. Not paid until the end of the year. | show 🗑
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| show | Preferred Provider Organization (PPO)
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| A physician-owned business that has the flexibility to deal with all forms of contract medicine and also offers its' own plan is a/an? A: PPO B: PPG C: POS D: IPA | show 🗑
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| A program that offers a combination of HMO style cost management and PPO style freedom of choice is known as a? A: EPO B: POS C: MCO D: PPG | show 🗑
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| show | Collect the copayment when the patient arrives for the office visit.
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| show | The Center for Medicare and Medicaid Services.
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| show | Hospice Care
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| show | Diagnostic tests
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| show | Has not been a bed patient in any hospital or NF for 60 consecutive days.
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| show | The deductible not covered under Medicare.
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| Some senior HMOs may provide services not covered by Medicare, such as? A: Vaccines and ambulance services. B: Mammograms and Pap smears. C: Laboratory and X-ray services. D: Eyeglasses and Prescription drugs. | show 🗑
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| The abbreviation MCO stands for? | show 🗑
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| A primary care physician who controls patient acces to specialists is called a/an? | show 🗑
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| show | Utilization Review. REMEMBER, USUALLY PERFORMED BY A RN IN A INPATIENT SETTING.
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| show | Preauthorization or Preapproval.
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| Medicare outpatient coverage is referred to as Part (BLANK)? | show 🗑
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| show | The letter B
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| show | Medigap.
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| show | Limiting Charge
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| show | $500.00
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| An NPI number is issued to a provider by CMS is the acronym for (BLANK) | show 🗑
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| A patient classified with ESRD may be provided benefits from Medicare. What does ESRD stand for? | show 🗑
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| What type of coverage does a Medi-Medi patient have? | show 🗑
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| show | True
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| Medicare eligible patients are not involved with HMOs or prepaid health plans. | show 🗑
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| show | True.
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| show | 80% of the Medicare approved charge.
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| In the Medicare program, there is mandatory assignment for? A: Surgery performed in the Physician' office. B: E/M Services C: Clinical Laboratory Tests. D: ECGs | show 🗑
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| show | B: GA
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| Payments to hospitals for Medicare services are classifed according to? A: CPT codes B: DRGs C: ICD-9-CM codes D: PTMs. | show 🗑
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| show | A: Fiscal Inermediaries.
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| The time limit for submitting a Medicare claim is?` | show 🗑
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| show | Crossover claim.
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| show | True
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| Medicare- eligible patients are not involved with HMO or prepaid health plans. | show 🗑
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| In a staff model HMO, physicians are hired directly by the health plan that pays their salary. | show 🗑
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| show | True.
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| In certain managed care plans, there is an incentive for the gatekeeper to limit patient referrals to specialist. | show 🗑
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| show | False.
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| show | False.
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| A copayment in a managed care plan is usually a fixed dollar amount or predetermined fee. | show 🗑
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| Medicare provides insurance for disabled individuals if they received SS diability benefits for 24 months. | show 🗑
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| All persons age 65 who meet eligibiltiy requirements for Medicare receive Medicare Part B (outpatient coverage). | show 🗑
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| show | True.
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| show | True.
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| show | True.
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| Employee and Employer contributions help pay for Medicare Part A health services. | show 🗑
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| show | False.
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| show | False. This is Medicare Part B.
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| show | True.
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| show | False. Penalties apply.
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| show | True. Case by case basis.
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| A nonparticipating physician who is not accepting assignment may bill any fee he/she wishes. | show 🗑
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| show | False. Think geographic cost index (cost of living index)
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| Medicare transmits Medigap claims electronically for the participating physicians when Medigap information is provided on the original Medicare Claim. | show 🗑
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| show | False. But occasionaly true if the the beneficiary submits for payments paid at time of service.
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