What does CCA stand for?
a. Certificate of Corporate Agreement
b. Certificate of Compliance Analysis
c. Certificate of Compliance Agreement
d. Certificate of Compliance Amalgamation
(
Q. 2) In addition to the MCP transferring all or part of the risk to the Group/IPA, the Group/IPA may transfer some or all of their risk to an individual capitated provider as well. The levels of risk transferred to the capitated provider include:
a. No referral risk transferred
b. Arranged risk transferred
c. Substantial risk transferred
d. Stop loss protection
(
Q. 3) Medicare is the Federal Health Insurance Benefit Plan for the Aged and Disabled, Title XVIII of Public Law 89-97 of the Social Security Act of 1965. This program is for people 60 years of age or older and certain persons who are totally disabled.
Indicate whether this statement is true or false.
(
Q. 4) All of the following are causal factors for reversals EXCEPT:
a. An accident which was thought to be WC turns out to be the responsibility of the injured
b. When a patient hides or omits facts regarding when and how the accident occurred
c. A claims examiner rules in favor of the employee
d. If there is a nonindustrial, underlying condition which caused the accident
(
Q. 5) What is one advantage of SDP?
a. Self-disclosure gives employees a way to come clean.
b. Self-disclosure gives providers a way to investigate employees without them knowing it.
c. Self-disclosure gives providers the opportunity to avoid the costs and disruptions associated with an OIG-directed investigation or audit.
d. Self-disclosure gives employees job security.
(
Q. 6) Stop-loss is an attempt to limit payments by an insured person or a Group/IPA in the case of a catastrophic illness or injury to a member.
Indicate whether this statement is true or false.
(
Q. 7) Additional factors which may delay the close of a case include which of the following?
a. Confusion or questions on any of the reports submitted by the employer
b. Excessive information on a report
c. The medical biller's vacation schedule
d. Sufficient progress reports to update the insurance carrier on the status of the patient
(
Q. 8) When does the physician submit the Physician's Final Report?
a. When the patient has been discharged
b. When the patient has agreed to file a claim
c. When the patient has received the benefits
d. When the patient has found another job
(
Q. 9) An audit scope details what is being investigated, who will conduct the audit, and when the process will occur.
Indicate whether this statement is true or false.
(
Q. 10) Medicare eligibility is provided based on all of the following EXCEPT:
a. Age
b. Disability
c. ESRD
d. DRG
Quick Reply
