Describe the ways that benefits for x-rays and labs are handled.
What will be an ideal response?
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Q. 2) Which of the following is an advantage to the provider associated with being in a PPO?
a. Decreased patient volume
b. Deferred claim payment
c. Reduced financial risk due to automatic assignment of benefits
d. Active participation in international cost-containment efforts
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Q. 3) Preferred provider organization (PPO) packages may involve which of the following?
a. Contractual agreements for a limited number of healthcare services
b. Guidelines to increase the amount of testing performed
c. Suggestions for more comprehensive insurance plans
d. Arrangements in which the PPO provider is paid over a period of 5 years
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Q. 4) What is managed care?
a. A strategy for managing the care of adoptive infants before the adoption goes through
b. A strategy for reducing or controlling healthcare costs by closely monitoring and restricting the use and cost of services
c. A system in which the insurance biller manages the delivery of healthcare and controls costs by emphasizing primary and preventive care services
d. Plans that use claim examiners and utilization review to ensure the appropriate delivery of care
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Q. 5) What is a part of a utilization review?
a. Precertification (prior to) or prospective review
b. Prevailing review (during the confinement)
c. Post-review (after termination of confinement)
d. Post-traumatic stress review (to determine level of trauma)
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Q. 6) What is precertification?
a. Preapproval for admission on an elective, nonemergency hospitalization
b. Nonemergency hospitalization approved by a plastic surgeon
c. Preapproval by a specific group of claim examiners
d. Preapproval by an insurance biller
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Q. 7) PAT stands for:
a. Preallowance testing
b. Preallotransplantation
c. Preadmission testing
d. Preallergic transition
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Q. 8) Which of the following is typically a part of a fee schedule?
a. The estimated amount payable for particular services
b. Fees assigned according to the particular APP code
c. The allowable amount for that particular procedure
d. The allowed percentage of wages garnished if fees are not paid on time
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Q. 9) Which of the following is a reason to use a modifier when coding?
a. When codes are newly issued by the federal government
b. If a patient receives multiple radiology tests in the same setting on the same day
c. When the Federal Register's website is down
d. If CMS guidelines have been enforced for a period of over 6 months
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Q. 10) What is the Geographical Practice Cost Index (GPCI)?
a. A fee charged in the state of Florida because of the high concentration of older population
b. A fee charged in the case of natural disasters (floods, tornadoes, other violent weather)
c. A fee usually charged by similar providers for the same procedure in the same geographic area during a specified period of time
d. A fee charged by providers because more and more patients buy pharmaceuticals in Canada
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