Exam 17: Insurance and Billing

A feature of Blue Cross/Blue Shield (BCBS) is ____.

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. Which plan will be the primary payer for the children?

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

A fixed prepayment is made to a physician for each plan member in the ________ payment method.

In which program can enrollees who are aged 65 and older continue to obtain medical services at military hospitals and clinics as they did before they turned 65?

Which of the following is included under Workers' Compensation insurance in most states?

Under a Medicare Managed Care Plan, the PCP provides treatment and manages the patient's medical care through ________ to specialists when additional care is required.

A patient who has been hospitalized up to 90 days for each benefit period is covered under ____.

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

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

The determination of the amount of money paid by a third-party payer for a procedure is ____.

Some payers offer an Internet-based service called ________ data entry, or DDE, that allows medical offices to enter data without EDI formatting.

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

Federal law requires employers to purchase and maintain a certain minimum amount of workers' ________ insurance for their employees.

The ________ is a fixed amount that must be paid by the policyholder each year before a third-party payer begins to cover medical expenses.

Because Medicare pays 80% of approved charges and the patient is responsible for the remaining 20%, individuals enrolled in the Original Medicare Part B plan often buy additional insurance called a(n) ________ plan.

Which of the following types of insurance covers injuries that are caused by the insured or that occurred on the insured's property?

A small fee that is collected at the time of service is called a(n) _______.

Of the federal programs providing healthcare, the largest is ____, which provides health insurance for citizens aged 65 and older.

TRICARE and CHAMPVA cover ____.