question

Numerical values are assigned to medical servicess based on nationwide research in a_____.

answer

relative value scale (RVS)

question

The Centers for Medicare and Medicaid Services(CMS) Resource-Based Relative Value Scale (RBRVS) bulids on the RVS method by adding factors for______.

answer

Provider Expenses

question

The comparison of the usual fee and individual physicain charges for a service the customary fee charged by most physicians in the community and the reasonable fee for service is known as what approach?

answer

usual, customary, and reasonable (UCR)

question

Fees that physicians charge to most of their patients most of the time under typical conditions are_____.

answer

usual fees

question

If a patient makes a payment at the time of service, a medical billing program is used print an____.

answer

walkout receipt

question

Whether a physician participates in a plan or not is decided by_____.

answer

the physician

question

Within a managed care organization the gatekeeper is another name for a_____.

answer

primary care physician

question

Who makes referral for patients in an HMO?

answer

both the gatekeeper and the primary care physician

question

Which of the following do not usually file claims for patients?

answer

non-participating physicians

question

The first step in calculating RBRVS is to determine the______.

answer

procedure codes

question

The abbreviation PPO stands for_____.

answer

preferred provider organization

question

In some plans, a primary care physician (PCP) is assigned to______.

answer

each patient

question

What should explain what is required of the patient financially when payment is due?

answer

financial policy

question

Positive or negativce corrections to a patients account such as returned check fees are called_____.

answer

adjustments

question

What does the abbreviation RVS stand for?

answer

relative value scale

question

Out-of-pocket medical expenses are paid by the_____.

answer

patient

question

Undder a point-of-service (POS) plan an HOM patient who does not to be limited to network providers might have to make_______.

answer

larger payments

question

What document can the patient use to report the charges and payments to the insurance company?

answer

walkout receipt

question

If a practice has not accepted assignment and collects payment from the patient at the time of service and then sends a claim to the plan on behalf of the patient what should the patient expect as the next course of action?

answer

receive a reimbursement check from the insurance company

question

Which plan must meet a high deductible before the health plan can make a payment?

answer

consumer-driven health plan

question

For which type of insurance plan would the medical assistant verify the patients deductible the coverage benefits and the coinsurance or other financial information?

answer

high deductible paln

question

Which method does Medicare use to pay physicians in group practices?

answer

Resource-based relative value scale (RBRVS)

question

What percentage of the allowed charge does Medicare Part B Original Plan cover after the patient meets their annual deductible?

answer

80%

question

What percentage of the allowed charges is the patient responsible for through the Original Medicare plan after the patient meets their annual deductible?

answer

20%

question

Which of the following is not a typical time-of-service payment?

answer

registration fees

question

What is not a part of the real-time claims adjudication (RTCA).

answer

receive real-time payment

question

After checkout, what is a next step in the billing cycle?

answer

send claim for insurance payments

question

In order, what are the next steps in the billing cycle after the patient checks out?

answer

file claim, insurance payment, and patient billed for what they owe

question

Which of the following is not taken into account when determining resource-based fee structures?

answer

how many credentials the physician performing the procedure has

question

What does Real Time Claims Adjudication not generate?

answer

"real-time" payment

question

What is the goal of an effective patient checkout procedure?

answer

the patient understands financial responsibility

question

Which is not part of the RBRVS fee?

answer

UCR

question

Which should be paid at the time of servive?

answer

previous balances

question

Which type of payment is made during checkout based on an estimade?

answer

partial payment

question

A preauthorization form is typically used with which type of transactions?

answer

credit card

question

Which of the following is not usually accepted form of payment?

answer

wire transfer

question

What does it mean when a provider accepts assignment?

answer

to accept the allowed charge as full payment

question

Under what conditions of HIPPA is it permissible to bill a patient a reasonable chrage?

answer

copies of medical records

question

If patients have large bills that they must pay over time what can be set up for them?

answer

payment plan

question

What is one way a practice can help patients determine what they may owe?

answer

swipe card reader

question

Which health plan has a rule that prohibits physicians from obtaining any patient payment except a copayment until after the claim is paid?

answer

Medicare

question

What might a contract between a health plan and provider entail?

answer

to prohibit balance billing

question

Whaen are payments from the patient entered and the account updated?

answer

after the patients visit

question

What does the Real-Time Claims Adjucation tool not provide?

answer

exact payment due

question

In what situation is the patient offered a walkout receipt?

answer

the patient made a payment at the end of a visit

question

What summarizes the services and charges for that day as well as any payment the hpatient made?

answer

walkout receipt

question

If the practice accepts credit and debit cards what standards must be followed?

answer

PCI DSS

question

All of the following procedures are completed at the end of a patients visit, except:

answer

insurance is verified

question

What is the tool for calculating charges due at the time of service?

answer

real-time claims adjudications (RTCA)

question

To estimate charges the patient will pay the medical assistant verifies:

answer

deductible amount

question

What might a health plan require if the patient has more than one covered service in a single day?

answer

multiple copayments

question

Which of these payment methods is the basis for Medicares fees?

answer

RBRVS

question

Which answer correctly lists the main methods payers use to pay providers?

answer

allowed charges contracted fee schedule and capitation

question

If a providers charge is higher than the allowed amount the providers reimbursement is based on____.

answer

the amount allowed

question

If the providers charge is lower than the allowed amount the reimbursement is based on_____.

answer

the amount billed

question

Under a contracted fee schedule, the allowed amount is______compared to the providers charge.

answer

the same

question

The deductibles, coinsurance, and copayments patients pay are called their_______.

answer

out-of-pocket expenses

question

If a nonparticipating providers usual fee is $600, the allowed amount is $300 and balance billing is permitted what amount is written off?

answer

$0

question

An option in an HMO that allows patients to use non-HMO providers is called______.

answer

a point-of-service option

question

If a participating providers usual charge is higher than the allowed amount and balance billing is not permitted what should the difference between the two charges become?

answer

a write off

question

Before the payer begins to pay benefits what must a policyholder pay annually under a typical indemnity plan?

answer

deductible

question

Under most managed care plans what must patients pay to the provider at the time of service?

answer

copayment

question

Medical insurance plans require patients to pay for all services that are_____.

answer

both excluded and over-limit

question

At what pount in the billing process might a physician practice decide to have a policy to collect patients payments?

answer

both claims processing and adjudication

question

Collecting the difference between a providers usual fee and a payers lower allowed charge from the insured is called?

answer

balance billing

question

What term describes a physician who does not participate in a particualr plan?

answer

Non-PAR

question

The amount of a copayment is determined by_____.

answer

the insurance carrier/health plan

question

If the participating providers charge is higher than the allowed amount which is the basis for reimbursement?

answer

allowed amount

question

When is a capitated paymetn made to a provider?

answer

before services are given

question

A capitation payment covers the services for a health plan member for_____.

answer

a specific period of time

question

The abbreviation CDHP stands for_______.

answer

consumer-driven health plan

question

What are patients who do not have insurance coverage called?

answer

self-pay

question

Discounted fee-for-service arrangements are also known as_____.

answer

contracted fee schedules

question

A list of charges for the procedures and services a physician performs is a___-.

answer

fee schedule

question

The abbreviation HMO stands for______.

answer

health maintenance organization

question

What must be met before benefits from a payer begin?

answer

deductible

question

Which of the following is not a component of a network created by a PPO?

answer

patients

question

A PPO plan will pay lower benefits if a patient sees a provider who is_____.

answer

out-of-network

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