Midterm Part 7 Flashcards
Which of the following services is(are) covered by Medicare part B?
A. Laboratory tests
B. All of the above
C. Services in an outpatient
D. Services in an emergency department
All of the above
TRUE/FALSE: In the episode-of-care reimbursement approach, providers are reimbursed a lump sum for all provided services related to a patient’s condition or disease.
True
Which type of health insurance covers the medical expenses of individuals ( e.g. private health insurance) and groups (e.g. employer group health insurance)?
A. Commercial
B. Disability
C. Liability
D. Workers’ compensation
Commercial
The guarantor had paid $2000 as coinsurance on various medical bills. Per the healthcare insurance policy, the health care insurance policy, the Health care insurance plan would now pay 100% of the remaining bills with no coinsurance being assessed to the guarantor. What type of provision does this clause in the policy represent?
A. Catastrophic expense limit
B. Stop loss benefits
C. All of the above
D. Maximum out of pocket cost
All of the above
If normal fee is $500 but the physician agreed with a payer to accept $450, the remaining $50 is a ______.
A. Accounts receivable
B. Capitation
C. Contractual adjustment
D. Withhold
Contractual adjustment
If a patient has Blue Cross/Blue Shield through their spouse’s employer, but is also a Medicare beneficiary, Medicare would be:
A. Primary payer
B. Not billed in this case at all
C. Secondary payer
D. Primary payer, but only as long as the patient was 65 or over
Secondary payer
MACRA makes important changes to how Medicare pays those who provide care to Medicare beneficiaries by ________.
A. Creating a new framework for rewarding healthcare providers for delivering better care, not just more care
B. Implementing an SGR formula for determining Medicare payments for healthcare providers’ services
C. Initiating the physician quality reporting system (PQRS), the value-based payment modifier (VM)
D. Enhancing payment adjustments for existing quality report in programs, such as the meaningful use program
Creating a new framework for rewarding healthcare providers for delivering better care, not just more care
A group without walls (GPWW) establishes a contract that allows physicians to maintain their own offices and share services, such as _______.
A. Performing surgical procedures
B. Appointment scheduling and billing
C. Admitting patients to the hospital
D. Providing office services to patients
Appointment scheduling and billing
Which of the following is true about Medicare part A insurance?
A. It is a voluntary insurance program that covers all physician and hospitalization costs
B. It covers the cost of outpatient services
C. It provides hospitalization insurance for those 65 or older who are eligible for Social Security or railroad retirement benefits
D. It covers the cost of skilled nursing care
It provides hospitalization insurance for those 65 or older who are eligible for Social Security or railroad retirement benefits
Which program pays for a physician services, outpatient hospital care, and durable medical equipment?
A. Medicare Part B
B. Medicare Part C
C. Medicare Part A
D. Medicare Part D
Medicare Part B
In the accounting system of the physician office, the account is categorized as “self-pay”. How should the insurance analyst interpret this category?
A. The physician, himself, or herself, will pick up the balance of the bill
B. The guarantor will pay the entire bill
C. The employer’s self-insured healthcare insurance plan will cover the amount
D. The patient and will pay deductibles and non-covered charges
The guarantor will pay the entire bill
