Insurance companies define the services they will pay for by which of the following categories?
a. Medical, laboratory, nursing, and supplies
b. Medical, laboratory, and x-ray
c. Medical, surgery, laboratory, and anesthesia
d. Laboratory, surgery, and anesthesia
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Q. 2) What factor is the final consideration before a final fee determination can be made?
a. Geographic location
b. Specialty of the physician
c. Number of patients in a practice
d. Number of patients seen each day
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Q. 3) Relative value scales are based on the skill needed to perform a procedure, the overhead costs, and the:
a. geographic location.
b. potential for malpractice law suits.
c. redeemable value.
d. number of visits required to complete the procedure.
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Q. 4) One way to determine fee that are UCR is according to what scale?
a. Kaiser
b. Geographical
c. Relative value
d. Medicare
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Q. 5) The R in UCR refers to the:
a. reimbursement amount.
b. reasonable amount.
c. rest home amount.
d. rescuer amount.
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Q. 6) Some physicians will require the patient to ______ if the procedure involves a high deductible or is not covered under the person's insurance plan.
a. pay the entire amount prior to the procedure
b. sign a payment plan
c. wait to have the procedure
d. have a different procedure
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Q. 7) The range of fees providers charge in a geographical area for the same service is the _____ of UCR.
a. customary fee
b. usual fee
c. reasonable amount
d. None of the above
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Q. 8) The amount a provider typically charges for a procedure is the ______ of UCR.
a. customary fee
b. usual fee
c. reasonable amount
d. None of the above
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Q. 9) Although illegal, why would employers choose not to hire someone who has had a great deal of medical expenses in the past?
a. The person might miss a lot of work in the future.
b. The person might have to go to a lot of doctor appointments.
c. The person might die.
d. The insurance premiums for the company might be based on the medical expenses of the group of individuals insured.
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Q. 10) The allowable amount refers to:
a. the amount of times the patient can be seen each year.
b. the amount allowable to be paid at one time to a provider.
c. the amount the insurance company will pay for a certain procedure or visit.
d. the amount the physician can charge for an encounter.
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