Exam 17: Insurance Billing

A fixed prepayment is made under contract to a medical provider for each plan member in the ________ payment method.

How should data in medical billing programs be entered?

Who most frequently files insurance claims and handles insurers' payments for a medical practice?

What is the term for the 10-digit number that identifies the physician's medical specialty?

Which of the following guidelines is applicable when filing a Medicaid claim and interacting with Medicaid patients?

The health plan that pays for medical services is known as a __________ payer.

Which of the following is not part of Medicare's resource-based relative value scale?

What is the birthday rule?

The main goal of the _________ model is to change the organization and delivery of primary health care in America.

Patients under the age of 65 who are blind or widowed or who have serious long-term disabilities, such as ____, may be entitled to Medicare.

Billing the patient for the difference between a higher usual fee and a lower allowed charge is called ________ billing.

Mrs. Lawrence is an elderly diabetic patient who is on Medicare. She recently injured her lower left leg, and since then has had trouble with open sores or ulcers on that leg. She came to the office last week to have the physician examine and treat the ulcers. At that time, you checked, and she qualified for Medicaid as well as Medicare. She has come to the office today for follow-up care and treatment. Which of the following should you do first?

Which Medicare plan covers prescription medications?

Greg Owen is in the office today for treatment of a small but deep cut he received while cutting laminate for the new floor in his kitchen. He has employer-provided insurance and is also listed as a dependent on his wife's insurance. His DOB is 7/19/1973 and his wife's DOB is 5/23/1978. Who is the primary payer in this case?

Which of the following must be verbally discussed with a Medicare beneficiary to enable the beneficiary to consider options and make informed choices?

Billing programs used to exchange health information about the practice's patients with health plans use an electronic data ________ to send information quickly and securely.

The request for approval for payment from a third-party payer prior to a procedure is the ____.

Under a Medicare managed care plan, the primary care physician (PCP) provides treatment and manages the patient's medical care through ________ to specialists when additional care is required.

Which of the following groups are not covered by TRICARE or CHAMPVA?

Payments made by a health plan for medical services provided to the patient are known as ________.