Question

Answer Multiple chooses

1.Under an insurance contract, the patient is the first party and the physician is the second party. Who is the third party

PCP

insurance plan

federal government

2.For a patient insured by an HMO, the phrase "out-of-network" means providers who are

Question options:

not under contract with the payer

whose offices are more than 50 miles from the patient

licensed by the state

3.What demonstrates to outside investigators that the practice has made honest, ongoing attempts to find and fix weak areas?

Question options:

having a compliance plan in place

purchasing current reference materials

hiring a consultant

4.Assignment of benefit authorizes

Question options:

the physician to file claims for a patient and receive direct payments from the payer

the payer to send payments directly to the patient

the physician to give patients completed claim forms to send to payers

5.Which of the following are NOT considered fraud and abuse?

Question options:

Billing for a chest x-ray not performed

Billing a screening mammogram on a 28-year-old with a family history of breast cancer

Performing cardiac stinting on all patients with hypertension

6.A managed care payer often requires a prior authorization before certain services are performed. Which of the following services would most likely NOT require prior authorization?

Question options:

MRI

cholesterol

hospitalization

Answer 1

1.Under an insurance contract,the patient is the first party and the physician is the second party.who is the third party Federal government

2. For a patient insured by an HMO, the phrase' out of net work' means providers who are not under contract with the payer

3.What demonstrates to outside investigators that the practice has made honest , ongoing attempts to find and fix weak areas Hiring a consultant   

4. Assignment of benefit authorizes The physician to give patients completed claim forms to send to payers

5.Which of the following are not considerd fraud and abuse Billing a screening mammogram on a 28 year old with a family history of breast cancer

6.A managed care payer often requires a prior authorization before certain sevices are performed. which of the following services would most likely not require prior authorization? Cholesterol