The medical biller should be _____________________ with MCPs to accurately bill for services outside of the capitation services.
a. familiar
b. smart
c. negotiable
d. kind
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Q. 2) Physicians may be owed additional ____________________ amounts for new members who do not choose a PCP and to whom a physician is assigned after a given period of time.
a. exclusionary
b. withheld
c. capitation
d. copayment
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Q. 3) When there is a discrepancy with the eligibility roster and the patients seen, and the biller determines the error on the part of the HMO, a _______________________ is used to bill for the missing capitation amount.
a. Supplemental Capitation Request form
b. Error in Eligibility List Notification form
c. copy of the insured's membership card
d. health care claim form
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Q. 4) The medical biller will need to have good _____________________ skills in order to affect the monthly capitation payment to the provider.
a. financial
b. billing
c. customer service
d. people
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Q. 5) Providers are paid a capitation amount for each:
a. service.
b. patient enrolled in the program.
c. referral.
d. None of the above
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Q. 6) If a provider accepts a capitation amount for basic services and the patient requires services three times that month, the provider:
a. doesn't have to repay the MCP.
b. keeps the capitation amount and bills for the extra two visits.
c. keeps the capitation amount as payment in full.
d. is paid more the next month.
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Q. 7) When a provider accepts a capitation amount for basic services and the patient doesn't see the provider that month, the provider:
a. repays the MCP.
b. keeps the capitation amount.
c. carries the capitation amount over to the next month.
d. is paid less the next month.
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Q. 8) When an MCP contracts with a provider, the parties agree upon a _____________ that will cover all basic services required for members.
a. copayment
b. fee for service
c. capitation amount
d. deductible
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Q. 9) Most MCP programs are based on:
a. no risk.
b. shared risk.
c. partial risk.
d. full risk.
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Q. 10) In a shared-risk MCP package, the provider receives:
a. an eligibility list.
b. a service fee list.
c. a coverage list.
d. a capitation list.
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