Exam 6: Traditional Fee For Service/Private Plans

Employers cannot be "self-insured."

Name the two basic categories of health insurance.

Today,the "Blue System" is the largest single processor of Medicare Part A claims,which is commonly referred to as a:

Under the Affordable Care Act,insurance companies must cover certain preventive services without charging out-of-pocket costs.Name three.

Medicare fiscal intermediaries (FIs)and carriers are now more commonly referred to as Medicare administrative contractors (MACs).

Claims completion guidelines are the same for all government and commercial carriers.

Explain the term "reasonable and customary."

A system of payments established by the Centers for Medicare and Medicaid Services (CMS)to reimburse healthcare providers for treating Medicare patients.

In the case of "dual coverage," the primary carrier's explanation of benefits (EOB)should typically accompany the claim sent to the secondary insurer.

Under the Affordable Care Act,no annual dollar limits are allowed on most covered benefits beginning January 1,2014.

Blue Cross and Blue Shield claims must typically be filed within _____ following the last date of service provided to the patient.

The plan types within managed care plans include all of the following,except:

The yearly deductible (out-of-pocket payment)is the same for all commercial carriers.

What functions does a TPA perform?