The MCP may require an IPA to have a group of providers that cover most services for those members choosing the IPA as their:
a. insurance group.
b. PCP.
c. fee negotiator.
d. primary payer.
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Q. 2) In a partial-risk MCP package, the MCP pays the provider __________________ for basic services.
a. a fee for service
b. a capitation amount
c. a copayment
d. a deductible
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Q. 3) The most commonly used health care claim form used by managed care programs is the:
a. CMS-1500.
b. MCP specific.
c. HCFA-1450.
d. CMS-1450.
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Q. 4) In a no-risk MCP package, the MCP pays the provider:
a. a fee for service.
b. a capitation amount.
c. a copayment.
d. a deductible.
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Q. 5) It is possible that a member of an MCP will have to pay ____ copayments at one visit.
a. multiple
b. one
c. two
d. four
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Q. 6) A list of insured members who have chosen the provider as their PCP is called:
a. a member list.
b. an eligibility roster.
c. an insured member list.
d. None of the above
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Q. 7) Copayments within a managed care program vary according to the:
a. amount of time spent with the patient.
b. number of medications prescribed.
c. provider.
d. type of service.
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Q. 8) The primary out-of-pocket expense for a member of a managed care insurance program is the:
a. coinsurance.
b. deductible.
c. copayment.
d. fee for service.
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Q. 9) Providers who fail to verify eligibility at each patient visit:
a. will still get paid.
b. will be issued a warning notice.
c. risk not getting paid for nonverified visits.
d. could lose their MCP contract.
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Q. 10) If the managed care program provides an eligibility roster, and a patient's name is not on the list, the medical biller should:
a. call the MCP to see if the patient is active.
b. turn away the patient.
c. bill for the services anyway.
d. ask for private payment prior to the provider seeing the patient.
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