Question 1

Why should a medical office specialist be familiar with terms used in managed care contracts?

Accepted Answer

The medical office specialist (MOS) should be familiar with terms that are commonly used in managed care contracts; this enables the MOS to accurately submit insurance claims, obtain timely payment, and effectively discuss claims issues with patients and carriers.

Question 2

What is meant by the No Balance Bill provision in a managed care contract?

Accepted Answer

Physicians may not impose any surcharge or try to collect payment from covered persons for charges denied by the carrier. The combination of copayments, deductibles, and coinsurance from the patient and payment from the MCO constitutes payment in full.

Question 3

The maximum allowable fee payable for the provision of a particular contracted service by a physician is called the:

Accepted Answer

A)  reimbursement rate. 
B)  negotiated fee. 
C)  fee maximum. 
D)  capitation rate. 
A)  reimbursement rate. 
B)  negotiated fee. 
C)  fee maximum. 
D)  capitation rate. C

Question 4

Which type of payment method creates an incentive to provide more preventive care?

Accepted Answer

A)  capitation 
B)  per diem 
C)  per case 
D)  discounted fee-for-service 
A)  capitation 
B)  per diem 
C)  per case 
D)  discounted fee-for-service

Question 5

What information should be included in the schedule of benefits for a capitated plan?

Accepted Answer

This answer should discuss whi

Question 6

The ________ put an end to some of the worst insurance abuses and puts consumers, not insurance companies, in control of their healthcare.

Accepted Answer

Patient's

Question 7

The Affordable Care Act represents the most significant overhaul of the U.S. healthcare system since:

Accepted Answer

A)  the passing of Medicaid. 
B)  the passing of Medicare. 
C)  the passing of Obamacare. 
D)  Both A and B. 
A)  the passing of Medicaid. 
B)  the passing of Medicare. 
C)  the passing of Obamacare. 
D)  Both A and B.

Question 8

An increase in patient volume is often caused by:

Accepted Answer

A)  discounted fee-for-service contracts. 
B)  per diem and per case contracts. 
C)  percentage of premium and capitation contracts. 
D)  capitation contracts. 
A)  discounted fee-for-service contracts. 
B)  per diem and per case contracts. 
C)  percentage of premium and capitation contracts. 
D)  capitation contracts.

Question 9

PMPM stands for________.

Accepted Answer

per member

Question 10

Under a managed care contract, physicians cannot balance bill or impose any surcharge upon covered persons.

Accepted Answer

A) True 
 B)False

Question 11

Under a discounted fee-for-service arrangement, covered services are compensated at a discount of the provider's ________ charges.

Accepted Answer

The answer of Under a discounted fee-for-service arrangement, covered services...

Question 12

When a person has health insurance coverage through two or more plans, the determination of which plan will provide benefits as primary or secondary payer is known as:

Accepted Answer

A)  case management. 
B)  benefit determination. 
C)  coordination of benefits. 
D)  coordination of services. 
A)  case management. 
B)  benefit determination. 
C)  coordination of benefits. 
D)  coordination of services.

Question 13

Patients are typically very familiar with their health plan benefits when discussing claims issues with the medical office specialist.

Accepted Answer

A) True 
 B)False

Question 14

All the following are true regarding an ACO EXCEPT:

Accepted Answer

A)  It shares the patient's information with its network of providers. 
B)  It needs a patient's authorization to release medical information. 
C)  It is part of a Medicare Advantage plan. 
D)  It participates in a Medicare Shared Savings Program. 
A)  It shares the patient's information with its network of providers. 
B)  It needs a patient's authorization to release medical information. 
C)  It is part of a Medicare Advantage plan. 
D)  It participates in a Medicare Shared Savings Program.

Question 15

What types of information about a physician's background are examined in the credentialing process?

Accepted Answer

The physician's background is

Question 16

Explain how corporate business values are transforming healthcare delivery.

Accepted Answer

Because of rising costs, busin

Question 17

A managed care organization (MCO) uses a credentialing process to evaluate a provider's:

Accepted Answer

A)  medical credentials. 
B)  service fees. 
C)  workplace environment. 
D)  all of the above. 
A)  medical credentials. 
B)  service fees. 
C)  workplace environment. 
D)  all of the above.

Question 18

Provisions included in a managed care contract with a provider include:

Accepted Answer

A)  what is expected of the provider. 
B)  time limits for submitting claims. 
C)  reimbursement amounts. 
D)  all of the above. 
A)  what is expected of the provider. 
B)  time limits for submitting claims. 
C)  reimbursement amounts. 
D)  all of the above.

Question 19

Explain the coordination of benefits (COB) provision in a managed care contract.

Accepted Answer

COB is the determination of wh

Question 20

Explain the accountable care organizations.

Accepted Answer

The ACOs are a group of doctors, hospita

Why should a medical office specialist be familiar with terms used in managed care contracts?

What is meant by the No Balance Bill provision in a managed care contract?

The maximum allowable fee payable for the provision of a particular contracted service by a physician is called the:

Which type of payment method creates an incentive to provide more preventive care?

What information should be included in the schedule of benefits for a capitated plan?

The ________ put an end to some of the worst insurance abuses and puts consumers, not insurance companies, in control of their healthcare.

The Affordable Care Act represents the most significant overhaul of the U.S. healthcare system since:

An increase in patient volume is often caused by:

PMPM stands for________.

Under a managed care contract, physicians cannot balance bill or impose any surcharge upon covered persons.

Under a discounted fee-for-service arrangement, covered services are compensated at a discount of the provider's ________ charges.

When a person has health insurance coverage through two or more plans, the determination of which plan will provide benefits as primary or secondary payer is known as:

Patients are typically very familiar with their health plan benefits when discussing claims issues with the medical office specialist.

All the following are true regarding an ACO EXCEPT:

What types of information about a physician's background are examined in the credentialing process?

Explain how corporate business values are transforming healthcare delivery.

A managed care organization (MCO) uses a credentialing process to evaluate a provider's:

Provisions included in a managed care contract with a provider include:

Explain the coordination of benefits (COB) provision in a managed care contract.

Explain the accountable care organizations.

Introduction to Professional Billing and Coding Careers

Understanding Managed Care: Insurance Plans

Introduction to the Health Insurance Portability and Accountability Act Hipaa

ICD-10 Cm Medical Coding

Introduction to CPT and Place of Coding Services

Coding Procedures and Services

Hcpcs Coding and Compliance

Auditing

Physician Medical Billing

Hospital Medical Billing

Medicare Medical Billing

Medicaid Medical Billing

Tricare Medical Billing

Explanation of Benefits and Payment Adjudication

Refunds and Appeals

Workers Compensation

Filters

Exam 3: Understanding Managed Care: Medical Contracts and Ethics

Why should a medical office specialist be familiar with terms used in managed care contracts?

What is meant by the No Balance Bill provision in a managed care contract?

The maximum allowable fee payable for the provision of a particular contracted service by a physician is called the:

Which type of payment method creates an incentive to provide more preventive care?

What information should be included in the schedule of benefits for a capitated plan?

The ________ put an end to some of the worst insurance abuses and puts consumers, not insurance companies, in control of their healthcare.

The Affordable Care Act represents the most significant overhaul of the U.S. healthcare system since:

An increase in patient volume is often caused by:

PMPM stands for________.

Under a managed care contract, physicians cannot balance bill or impose any surcharge upon covered persons.

Under a discounted fee-for-service arrangement, covered services are compensated at a discount of the provider's ________ charges.

When a person has health insurance coverage through two or more plans, the determination of which plan will provide benefits as primary or secondary payer is known as:

Patients are typically very familiar with their health plan benefits when discussing claims issues with the medical office specialist.

All the following are true regarding an ACO EXCEPT:

What types of information about a physician's background are examined in the credentialing process?

Explain how corporate business values are transforming healthcare delivery.

A managed care organization (MCO) uses a credentialing process to evaluate a provider's:

Provisions included in a managed care contract with a provider include:

Explain the coordination of benefits (COB) provision in a managed care contract.

Explain the accountable care organizations.

Introduction to Professional Billing and Coding Careers

Understanding Managed Care: Insurance Plans

Introduction to the Health Insurance Portability and Accountability Act Hipaa

ICD-10 Cm Medical Coding

Introduction to CPT and Place of Coding Services

Coding Procedures and Services

Hcpcs Coding and Compliance

Auditing

Physician Medical Billing

Hospital Medical Billing

Medicare Medical Billing

Medicaid Medical Billing

Tricare Medical Billing

Explanation of Benefits and Payment Adjudication

Refunds and Appeals

Workers Compensation

Filters