Statistical sampling is a method whereby the auditor doesn't have to review every claim.
Indicate whether this statement is true or false.
(
Q. 2) Care for injuries occurring at workWhat is considered specialty care within an HMO plan?
a. Cosmetic surgery
b. Skilled nursing care
c. Medical marijuana prescriptions
d. Hospitalization
(
Q. 3) What is the purpose of preauthorization? How is it related to a TAR form? Identify and explain.
What will be an ideal response?
(
Q. 4) Which of the following is usually covered by an HMO?
a. Physician home visits
b. Abortion clinics
c. Prenatal care
(
Q. 5) Social Security Administration (SSA) offices throughout the United States take applications for Medicare, determine eligibility, and provide general information about the program.
Indicate whether this statement is true or false.
(
Q. 6) In the Network Model, the HMO contracts with several providers in a locale, disallowing overlap of geographic area.
Indicate whether this statement is true or false.
(
Q. 7) Independent Physician Associations (IPAs) are groups of providers who have banded together for the sole purpose of signing a contract with a Managed Care Plan.
Indicate whether this statement is true or false.
(
Q. 8) Which of the following are NOT considered WC claims for vocational rehabilitation?
a. Permanent nondisability claims
b. Temporary nondisability claims
c. Temporary ability claims
d. Permanent disability claims
(
Q. 9) Which of the following describes the use of a lien in a workers' compensation case?
a. A lien is completed and submitted to the insurance provider to be paid upon monetary settlement of the WC claim.
b. A lien should be sent along with copies of the insurance policy.
c. Whenever additional payments are made, a copy of the EOB should not be submitted to the attorney so that all payments will be included in the lien.
d. Lien forms can be obtained through the local Division of Industrial Accidents.
(
Q. 10) In an MCP situation, all of the following are considered risk determinations EXCEPT:
a. Full risk
b. Additional risk
c. Partial risk
d. Shared risk
Quick Reply
