Knowledge Evaluation - Medical Billing Trainer
This evaluation is designed to help us better understand your medical billing knowledge.
- 1.
Define the following term.Deductible:
- A.
A fixed dollar amount paid for a covered service by a beneficiary. Amount that a member of a health plan has to pay for specific health services, such as visits to a physician
- B.
A type of cost sharing where the beneficiary and insurance provider share payment of the approved charge for covered services in a specified ratio after payment of the deductible by the insured. For example, for Medicare physicians' services, the beneficiary pays co-insurance of 20 percent of allowed charges.
- C.
A provision that applies when a person is covered under more than one group medical program.
- D.
(1) The amount the patient pays for medical care before insurance covers the balance. (2) A type of cost sharing where the beneficiary pays a specified amount of approved charges for covered medical services before the insurer will pay for all or part of the remaining covered services. (3) Total amount a member of a health plan has to pay for services before that person's plan begins to cover the costs of care.
Correct Answer
D. (1) The amount the patient pays for medical care before insurance covers the balance. (2) A type of cost sharing where the beneficiary pays a specified amount of approved charges for covered medical services before the insurer will pay for all or part of the remaining covered services. (3) Total amount a member of a health plan has to pay for services before that person's plan begins to cover the costs of care.Explanation
A deductible is the amount that a patient must pay for medical care before their insurance coverage kicks in and covers the remaining balance. It is a form of cost sharing where the patient is responsible for a specified amount of approved charges for covered medical services. The deductible is the total amount that a member of a health plan must pay for services before their plan starts covering the costs of care.Rate this question:
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- 2.
Define the following term.Carve-out Policy:
- A.
The method by which a patient’s health care service claims are review before reimbursement is made. This is done to validate the appropriateness of services given and that the cost is not excessive.
- B.
A contracted agreement between an insurance company and another company/healthcare provider which provides special services to its members, such as prescription drugs, pediatric vaccinations, or cancer treatment.
- C.
Free or reduced-fee care provided due to financial situation of patients. Legally, the charge(s) must be entered on the patient ledger as the Usual & Customary charge(s); then can be adjusted or written off.
- D.
The process which allows you to process a group of entries, versus one entry at a time.
Correct Answer
B. A contracted agreement between an insurance company and another company/healthcare provider which provides special services to its members, such as prescription drugs, pediatric vaccinations, or cancer treatment. -
- 3.
Define the following term.Ancillary Providers:
- A.
Services over and above physician services, including laboratory, radiology, home health and skilled nursing facilities.
- B.
Surgery done in the physician’s office or at a surgical center, and not requiring an overnight stay.
- C.
A process under which Medicare/insurance carrier pays its share of the allowed charge directly to the physician or supplier. Medicare will do this only if the physician accepts Medicare's allowed charge as payment in full.
- D.
How physician's services are identified and defined.
Correct Answer
A. Services over and above pHysician services, including laboratory, radiology, home health and skilled nursing facilities.Explanation
Ancillary providers refer to services that are provided in addition to physician services. These services can include laboratory tests, radiology procedures, home health care, and skilled nursing facilities. They are considered separate from the primary care provided by physicians. This definition does not include the other options mentioned in the question, such as surgery done in the physician's office or the process of Medicare/insurance payments.Rate this question:
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- 4.
Define the following term.Co-insurance:
- A.
A fixed dollar amount paid for a covered service by a beneficiary (guarantor). Amount that a member of a health plan has to pay for specific health services, such as visits to a physician.
- B.
A type of cost sharing where the beneficiary and insurance provider share payment of the approved charge for covered services in a specified ratio after payment of the deductible by the insured. For example, for Medicare physicians' services, the beneficiary pays co-insurance of 20 percent of allowed charges.
- C.
The amount the patient pays for medical care before insurance covers the balance
- D.
A form of payment made by the insurance company in advance of medical services received; the prepayment by the insurance carrier of a fixed amount, usually monthly, to a physician (PCP) to cover services for a member of a particular plan (HMO).
Correct Answer
B. A type of cost sharing where the beneficiary and insurance provider share payment of the approved charge for covered services in a specified ratio after payment of the deductible by the insured. For example, for Medicare pHysicians' services, the beneficiary pays co-insurance of 20 percent of allowed charges. -
- 5.
Define the following term.Capitation:
- A.
A type of cost sharing where the beneficiary and insurance provider share payment of the approved charge for covered services in a specified ratio after payment of the deductible by the insured. For example, for Medicare physicians' services, the beneficiary pays co-insurance of 20 percent of allowed charges.
- B.
Total amount a member of a health plan has to pay for services before that person's plan begins to cover the costs of care.
- C.
A fixed dollar amount paid for a covered service by a beneficiary (guarantor). Amount that a member of a health plan has to pay for specific health services, such as visits to a physician.
- D.
A form of payment made by the insurance company in advance of medical services received; the prepayment by the insurance carrier of a fixed amount, usually monthly, to a physician (PCP) to cover services for a member of a particular plan (HMO).
Correct Answer
D. A form of payment made by the insurance company in advance of medical services received; the prepayment by the insurance carrier of a fixed amount, usually monthly, to a pHysician (PCP) to cover services for a member of a particular plan (HMO).Explanation
Capitation refers to a form of payment made by the insurance company to a physician in advance of medical services being provided. This prepayment is usually a fixed amount, typically paid on a monthly basis, and is intended to cover the cost of services for a member of a specific health plan, such as an HMO.Rate this question:
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- 6.
Explain the usage of ICD-9 codes.
- 7.
Explain the usage of CTP-4 codes.
- 8.
Provide a brief explaination of the Claims Revenue Cycle.
- 9.
Explain the difference between an in-network and an out-of-network provider.
- 10.
Explain the function/benefit of using the services a claims clearinghouse.
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Current Version
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Mar 21, 2023Quiz Edited by
ProProfs Editorial Team -
Apr 20, 2010Quiz Created by
Rita754
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