Question 1

Name several types of Managed Care Plans.

Accepted Answer

HMO (Health Maintenance Organization)
PPO (Preferred Provider Organization)
EPO (Exclusive Provider Organization)
POS (Point-of-Service)

Question 2

What types of services are typically covered under the Medicaid Program?

Accepted Answer

Hospital Services
Prenatal Care
Physician Services
Pediatric Services
Vaccines for Children
EPSDT Services
Family Planning
Laboratory
Radiology
Home Health Care
Nursing Facility
Rural Health Clinic

Question 3

When patient balances are not satisfied within a specified period of time and regulatory requirements for patient notification have been met, the account will be sent directly to the credit bureau.

Accepted Answer

A) True 
 B)False  False

Question 4

Patients eligible for Medicare usually qualify as the result of:

Accepted Answer

A)  reaching age 65. 
B)  no income. 
C)  unemployment. 
D)  retirement. 
A)  reaching age 65. 
B)  no income. 
C)  unemployment. 
D)  retirement.

Question 5

The Medicare Part D program is free to all Medicare recipients.

Accepted Answer

A) True 
 B)False

Question 6

When the facility participates with the insurance carrier, what are their obligations? (Select all that apply.)

Accepted Answer

A)  Accept the allowance as payment in full. 
B)  File the claim for the patient. 
C)  Write off the difference between the charge and the allowance. 
D)  Never bill the patient. 
A)  Accept the allowance as payment in full. 
B)  File the claim for the patient. 
C)  Write off the difference between the charge and the allowance. 
D)  Never bill the patient.

Question 7

APC refers to a payment methodology utilized by Medicare for inpatient facility services.

Accepted Answer

A) True 
 B)False

Question 8

The term DRG refers to a reimbursement methodology employed by Medicare for inpatient services.

Accepted Answer

A) True 
 B)False

Question 9

Patient accounts that are outstanding are referred to as accounts receivable.

Accepted Answer

A) True 
 B)False

Question 10

Explain the difference between a denied claim and a rejected claim.

Accepted Answer

A rejected claim was returned without pa

Question 11

Which of the following items are usually included on the CDM of the facility? (Select all that apply.)

Accepted Answer

A)  Revenue Code 
B)  Description of Service 
C)  Department Code 
D)  DRG/APC Assignment 
A)  Revenue Code 
B)  Description of Service 
C)  Department Code 
D)  DRG/APC Assignment

Question 12

The guarantor is the individual responsible for ultimate payment for services performed.

Accepted Answer

A) True 
 B)False

Question 13

Under Health Maintenance Organization (HMO) managed care plan, the patient must utilize the HMO network, and, if so, no authorizations are necessary.

Accepted Answer

A) True 
 B)False

Question 14

Explain the primary difference in DRG and APC reimbursement methodologies.

Accepted Answer

DRGs, or diagnosis-related groups, are p

Question 15

What type of information is contained on the Remittance Advice or Explanation of Benefits?

Accepted Answer

Amount Charged
Contractual Amo

Question 16

The Medicare program that functions as a Medicare HMO and may be selected by Medicare recipients in lieu of their traditional Medicare coverage is known as:

Accepted Answer

A)  Medicare Part B. 
B)  Medicare Part A. 
C)  Medicare Part C. 
D)  Medicare Part D. 
A)  Medicare Part B. 
B)  Medicare Part A. 
C)  Medicare Part C. 
D)  Medicare Part D.

Question 17

The name given to any type of insurance carrier that implements methods to control healthcare costs such as co-payments, primary care physicians, and/or the need for authorization for services to be performed is a(n):

Accepted Answer

A)  HMO. 
B)  managed care plan. 
C)  indemnity plan. 
D)  liability coverage. 
A)  HMO. 
B)  managed care plan. 
C)  indemnity plan. 
D)  liability coverage.

Question 18

The computerized summary of services provided by the facility, including such information as CPT codes, revenue codes, charges, and department numbers is known as the:

Accepted Answer

A)  Charge description master (CDM). 
B)  the master list. 
C)  encounter form. 
D)  charge ticket. 
A)  Charge description master (CDM). 
B)  the master list. 
C)  encounter form. 
D)  charge ticket.

Question 19

A Preferred Provider Organization (PPO) is a type of managed care plan.

Accepted Answer

A) True 
 B)False

Question 20

The Medicare Remittance Advice indicates how a claim was processed by Medicare; for example, Paid/Denied, Allowance Amount, and Amount Paid.

Accepted Answer

A) True 
 B)False

Name several types of Managed Care Plans.

What types of services are typically covered under the Medicaid Program?

When patient balances are not satisfied within a specified period of time and regulatory requirements for patient notification have been met, the account will be sent directly to the credit bureau.

Patients eligible for Medicare usually qualify as the result of:

The Medicare Part D program is free to all Medicare recipients.

When the facility participates with the insurance carrier, what are their obligations? (Select all that apply.)

APC refers to a payment methodology utilized by Medicare for inpatient facility services.

The term DRG refers to a reimbursement methodology employed by Medicare for inpatient services.

Patient accounts that are outstanding are referred to as accounts receivable.

Explain the difference between a denied claim and a rejected claim.

Which of the following items are usually included on the CDM of the facility? (Select all that apply.)

The guarantor is the individual responsible for ultimate payment for services performed.

Under Health Maintenance Organization (HMO) managed care plan, the patient must utilize the HMO network, and, if so, no authorizations are necessary.

Explain the primary difference in DRG and APC reimbursement methodologies.

What type of information is contained on the Remittance Advice or Explanation of Benefits?

The Medicare program that functions as a Medicare HMO and may be selected by Medicare recipients in lieu of their traditional Medicare coverage is known as:

The name given to any type of insurance carrier that implements methods to control healthcare costs such as co-payments, primary care physicians, and/or the need for authorization for services to be performed is a(n):

The computerized summary of services provided by the facility, including such information as CPT codes, revenue codes, charges, and department numbers is known as the:

A Preferred Provider Organization (PPO) is a type of managed care plan.

The Medicare Remittance Advice indicates how a claim was processed by Medicare; for example, Paid/Denied, Allowance Amount, and Amount Paid.

The Flow of the Hospital Organization

Hospital Coding Overview

UB-04 Overview CMS-1450

Inpatient Coding

Inpatient Billing

Outpatient Coding

Outpatient Billing

Filters

Exam 3: Hospital Billing Overview

Name several types of Managed Care Plans.

What types of services are typically covered under the Medicaid Program?

When patient balances are not satisfied within a specified period of time and regulatory requirements for patient notification have been met, the account will be sent directly to the credit bureau.

Patients eligible for Medicare usually qualify as the result of:

The Medicare Part D program is free to all Medicare recipients.

When the facility participates with the insurance carrier, what are their obligations? (Select all that apply.)

APC refers to a payment methodology utilized by Medicare for inpatient facility services.

The term DRG refers to a reimbursement methodology employed by Medicare for inpatient services.

Patient accounts that are outstanding are referred to as accounts receivable.

Explain the difference between a denied claim and a rejected claim.

Which of the following items are usually included on the CDM of the facility? (Select all that apply.)

The guarantor is the individual responsible for ultimate payment for services performed.

Under Health Maintenance Organization (HMO) managed care plan, the patient must utilize the HMO network, and, if so, no authorizations are necessary.

Explain the primary difference in DRG and APC reimbursement methodologies.

What type of information is contained on the Remittance Advice or Explanation of Benefits?

The Medicare program that functions as a Medicare HMO and may be selected by Medicare recipients in lieu of their traditional Medicare coverage is known as:

The name given to any type of insurance carrier that implements methods to control healthcare costs such as co-payments, primary care physicians, and/or the need for authorization for services to be performed is a(n):

The computerized summary of services provided by the facility, including such information as CPT codes, revenue codes, charges, and department numbers is known as the:

A Preferred Provider Organization (PPO) is a type of managed care plan.

The Medicare Remittance Advice indicates how a claim was processed by Medicare; for example, Paid/Denied, Allowance Amount, and Amount Paid.

The Flow of the Hospital Organization

Hospital Coding Overview

UB-04 Overview CMS-1450

Inpatient Coding

Inpatient Billing

Outpatient Coding

Outpatient Billing

Filters