FINANCIAL CONSIDERATIONS

Question 1

these must be collected at the time of service to increase cash collections for practice, which supports the revenue cycle…

Answer 1

Out-of-pocket expenses

Question 2

it is not considered as part of the cost share
it must be paid monthly
it is paid by insured or employer
it is mandatory

Answer 2

Premium

Question 3

it must meet a certain amount yearly
it is paid by insured
it is a fixed amount
it must be paid before insurance will start paying for the covered benefits

Answer 3

Deductible

Question 4

deductible must be paid before this takes place
it is the amount shared with the Payer and Insured
the Payer usually pays more

Answer 4

Coinsurance

Question 5

it is paid at the time of service
it is a fixed amount
the amount of payment varies on type of visit

Answer 5

Copayment

Question 6

it is the most a member/family pay out of pocket for that given year

Answer 6

Out of Pocket Maximum (OOPM)

Question 7

patients who do not have insurance and pays in these ways

Answer 7

Self-pay pts, self-pay or private pay

Question 8

another payment option where it’s offered as employee benefits during open enrollment
the funds are tax-exempt
employer deducts a set amount from ea paycheck

Answer 8

Health Savings Account (HSA)

Question 9

this form serves as informed consent to transfer responsibility to the patient if Medicare does not pay for the service
documents the beneficiary’s decision about a service or procedure that Medicare may cover

Answer 9

Advance Beneficiary Notice of Noncoverage (ABN)

Question 10

it can either be private or group

Answer 10

Commercial health plans

Question 11

it covers the cost of health care services for the individual and/or family after the deductible and copays have been met

Answer 11

Insurance policies

Question 12

the more freedom a plan offers…

Answer 12

the higher the pt responsibility will likely be

Question 13

allows the patient to see providers within the network
no referrals required
more freedom to access the benefits
have coinsurance and deductible requirements
have a contracted group of providers
also called Fee-for-service (FFS)
monthly premium required

Answer 13

Preferred Provider Organization (PPO) plans

Question 14

it also have a contracted groups of providers, but, pt must choose a pcp

Answer 14

Point-of-service (POS) plans

Question 15

has a contract with a network pf providers for pt care
reimburse providers using a capitation method
no limit to the no. of times a pt may be seen

Answer 15

Health Maintenance Organization (HMO) plans

Question 16

a government plan that was establish in 1965
largest health insurance program in the US
eligible for individuals 65 yrs old or older

Answer 16

Medicare

Question 17

oversees the operations of Medicare

Answer 17

Centers for Medicare & Medicaid Services (CMS)

Question 18

selected by CMS to process Part A, B, FFS claims, & DME

Answer 18

Medical Administrative Contractors (MAC)

Question 19

composed of Medicare Advantage (MA) programs that allow all the same benefits as traditional Medicare and additional vision & dental services

Answer 19

Medicare Part C

Question 20

it is a program to assist qualified individuals who have low income with premiums, deductibles, copays, and coinsurance

Answer 20

Dual eligibility

Question 21

complete the parts of Medicare program from A-D

Answer 21

Part A - inpatient services
Part B - outpatient services
Part C - Medicare Advantage
Part D - Rx, Prescription

Question 22

a government program that assists qualified individuals with health care needs

Answer 22

Medicaid

Question 23

a supplemental policy to Medicare & offered by private insurance companies
help cover the costs of services that traditional Medicare doesn’t cover

Answer 23

Medigap

Question 24

a government program for active military and their families
retirees and surviving spouses also qualify

Answer 24

TRICARE

Question 25

members of TRICARE must be enrolled in this system

Answer 25

Defense Enrollment Eligibility Reporting Systems (DEERS)

Question 26

it is a method used reimburse providers to receive pre-established payments for health care services
no limit to number of times PT may be seen
reimbursement is the same
its period happens per month

Answer 26

Capitation Method