Question 1

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

Accepted Answer

Physicians may not impose any surcharge

Question 2

A managed care organization will contract with physicians, laboratories, pharmacies, hospitals, clinics, and other healthcare facilities in building a provider network.

Accepted Answer

A) True 
 B)False

Question 3

List the basic provisions of a managed care contract.

Accepted Answer

The contract outlines what is

Question 4

Which of the following is true of the Patient's Bill of Rights?

Accepted Answer

A) It is a written contract between the patient and provider. 
B) All MCOs have formally agreed to abide by its principles. 
C) It is an ethical standard adopted by an advisory commission on healthcare consumer protection. 
D) It is included in the physician's professional oath. 
A) It is a written contract between the patient and provider. 
B) All MCOs have formally agreed to abide by its principles. 
C) It is an ethical standard adopted by an advisory commission on healthcare consumer protection. 
D) It is included in the physician's professional oath.

Question 5

The contract provision that states a physician cannot seek payment from a patient under a managed care contract in relation to any benefit penalties that were applied based on a utilization review decision is:
A)no fault.
B)hold harmless.
C)stoploss coverage.
D)liability.

Accepted Answer

The answer of The contract provision that states a physician...

Question 6

What is the Patient's Bill of Rights?

Accepted Answer

The U.S. Advisory Commission on Consumer

Question 7

The maximum allowable fee payable for the provision of a particular contracted service by a physician is called the:
A)reimbursement rate.
B)negotiated fee.
C)fee maximum.
D)capitation rate.

Accepted Answer

The answer of The maximum allowable fee payable for the...

Question 8

With respect to National Committee for Quality Assurance (NCQA) accreditation:
A)MCOs must be accredited to operate.
B)MCOs have all asked to be accredited, but some do not qualify.
C)some MCOs are accredited, and some are not.
D)accredited MCOs are always better than nonaccredited MCOs.

Accepted Answer

some MCOs

Question 9

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 10

The healthcare delivery system involves a relationship between:
A)patients and providers.
B)providers and third-party payers.
C)patients and third-party payers.
D)patients, providers, and third-party payers.

Accepted Answer

patients,

Question 11

Explain how corporate business values are transforming healthcare delivery.

Accepted Answer

Because of rising costs, busin

Question 12

An individual who is an insured, enrolled subscriber or dependent under the terms of a health benefit plan is a(n):
A)contracted entity.
B)covered person.
C)payer.
D)provider.

Accepted Answer

The answer of An individual who is an insured, enrolled...

Question 13

A set of ethical standards designed to protect patients is known as the Patient's __________ .

Accepted Answer

The answer of A set of ethical standards designed to...

Question 14

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

Accepted Answer

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

Question 15

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

Accepted Answer

The physician's background is

Question 16

Under managed care contracts, the patient's choice of providers is usually more extensive than in traditional fee-for-service.

Accepted Answer

A) True 
 B)False

Question 17

A medical office specialist cannot be held liable for fraudulent billing practices if told to do so by a physician.

Accepted Answer

A) True 
 B)False

Question 18

A managed care contract will include a:
A)list of patients covered by the plan.
B)list of physicians in the network.
C)description of what types of employer groups are offered coverage.
D)description of how the physician will be paid for services.

Accepted Answer

description of how t

Question 19

Services provided to treat a medical condition that involves the sudden onset of acute symptoms of sufficient severity to threaten a person's life or health are:
A)urgent care.
B)medical care.
C)hospital care.
D)emergency care.

Accepted Answer

The answer of Services provided to treat a medical condition...

Question 20

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

Accepted Answer

A) True 
 B)False

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

A managed care organization will contract with physicians, laboratories, pharmacies, hospitals, clinics, and other healthcare facilities in building a provider network.

List the basic provisions of a managed care contract.

Which of the following is true of the Patient's Bill of Rights?

The contract provision that states a physician cannot seek payment from a patient under a managed care contract in relation to any benefit penalties that were applied based on a utilization review decision is: A)no fault. B)hold harmless. C)stoploss coverage. D)liability.

What is the Patient's Bill of Rights?

The maximum allowable fee payable for the provision of a particular contracted service by a physician is called the: A)reimbursement rate. B)negotiated fee. C)fee maximum. D)capitation rate.

With respect to National Committee for Quality Assurance (NCQA) accreditation: A)MCOs must be accredited to operate. B)MCOs have all asked to be accredited, but some do not qualify. C)some MCOs are accredited, and some are not. D)accredited MCOs are always better than nonaccredited MCOs.

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

The healthcare delivery system involves a relationship between: A)patients and providers. B)providers and third-party payers. C)patients and third-party payers. D)patients, providers, and third-party payers.

Explain how corporate business values are transforming healthcare delivery.

An individual who is an insured, enrolled subscriber or dependent under the terms of a health benefit plan is a(n): A)contracted entity. B)covered person. C)payer. D)provider.

A set of ethical standards designed to protect patients is known as the Patient's __________ .

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

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

Under managed care contracts, the patient's choice of providers is usually more extensive than in traditional fee-for-service.

A medical office specialist cannot be held liable for fraudulent billing practices if told to do so by a physician.

A managed care contract will include a: A)list of patients covered by the plan. B)list of physicians in the network. C)description of what types of employer groups are offered coverage. D)description of how the physician will be paid for services.

Services provided to treat a medical condition that involves the sudden onset of acute symptoms of sufficient severity to threaten a person's life or health are: A)urgent care. B)medical care. C)hospital care. D)emergency care.

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

Introduction to Professional Billing and Coding Careers

Understanding Managed Care: Insurance Plans

Hipaa: Health Insurance Portability and Accountability Act of 1996

ICD-9-CM Medical Coding

ICD-10-CM Medical Coding

Introduction to Cpt and Place of Service Coding

Coding Procedures and Services

Hcpcs and Coding 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

Electronic Medical Claims Processing

Filters

Exam 3: Understanding Managed Care: Medical Contracts and Ethics

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

A managed care organization will contract with physicians, laboratories, pharmacies, hospitals, clinics, and other healthcare facilities in building a provider network.

List the basic provisions of a managed care contract.

Which of the following is true of the Patient's Bill of Rights?

The contract provision that states a physician cannot seek payment from a patient under a managed care contract in relation to any benefit penalties that were applied based on a utilization review decision is: A)no fault. B)hold harmless. C)stoploss coverage. D)liability.

What is the Patient's Bill of Rights?

The maximum allowable fee payable for the provision of a particular contracted service by a physician is called the: A)reimbursement rate. B)negotiated fee. C)fee maximum. D)capitation rate.

With respect to National Committee for Quality Assurance (NCQA) accreditation: A)MCOs must be accredited to operate. B)MCOs have all asked to be accredited, but some do not qualify. C)some MCOs are accredited, and some are not. D)accredited MCOs are always better than nonaccredited MCOs.

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

The healthcare delivery system involves a relationship between: A)patients and providers. B)providers and third-party payers. C)patients and third-party payers. D)patients, providers, and third-party payers.

Explain how corporate business values are transforming healthcare delivery.

An individual who is an insured, enrolled subscriber or dependent under the terms of a health benefit plan is a(n): A)contracted entity. B)covered person. C)payer. D)provider.

A set of ethical standards designed to protect patients is known as the Patient's __________ .

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

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

Under managed care contracts, the patient's choice of providers is usually more extensive than in traditional fee-for-service.

A medical office specialist cannot be held liable for fraudulent billing practices if told to do so by a physician.

A managed care contract will include a: A)list of patients covered by the plan. B)list of physicians in the network. C)description of what types of employer groups are offered coverage. D)description of how the physician will be paid for services.

Services provided to treat a medical condition that involves the sudden onset of acute symptoms of sufficient severity to threaten a person's life or health are: A)urgent care. B)medical care. C)hospital care. D)emergency care.

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

Introduction to Professional Billing and Coding Careers

Understanding Managed Care: Insurance Plans

Hipaa: Health Insurance Portability and Accountability Act of 1996

ICD-9-CM Medical Coding

ICD-10-CM Medical Coding

Introduction to Cpt and Place of Service Coding

Coding Procedures and Services

Hcpcs and Coding 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

Electronic Medical Claims Processing

Filters