When a provider receives a fixed amount to provide only the care that an individual needs from the provider, this is known as a _____________ payment.

When a provider receives a fixed amount to provide only the care that an individual needs from the provider, this is known as a _____________ payment.

capitation

fixed

premium

sub-capitation

4 points

Question 2

The healthcare industry is heavily regulated by ____ and ____ legislation.

city; local

state; city

county; state

federal; state

4 points

Question 3

When a patient signs a release of medical information at a physician’s office, that release is generally considered to be valid

for six months

for a single visit to the physician

for one year from the date entered on the form

until the patient changes insurance companies

4 points

Question 4

When the provider is required to receive as payment in full whatever amount the insurance reimburses for services, the provider is agreeing to

accept assignment

assignment of benefits

authorize services

coordination of benefits

4 points

Question 5

Which document is used to guarantee the patient’s financial and medical record?

encounter form

patient insurance form

patient ledger

patient registration form

4 points

Question 6

The person responsible for paying the charges for services rendered by the provider is the

beneficiary

guarantor

guardian

subscriber

4 points

Question 7

Which federal legislation was enacted in1995 to restrict the referral of patients to organizations in which providers have a financial interest?

Federal Anti-Kickback Law

Hill-Burton Act

HIPAA

Stark II laws

4 points

Question 8

The recognized difference between fraud and abuse is the

cost

intent

payer

timing

4 points

Question 9

The specified amount of annual out-of-pocket expenses for covered health care services that the insured must pay annually for health care is called the

coinsurance

copayment

deductible

premium

4 points

Question 10

Which three components constitute the RBRVS payment system?

fee schedule, practice expense, and malpractice expense

physician work, practice expense, and geographical location

physician work, practice expense, and malpractice insurance espense

practice expense, malpractice insurance expense, and liability insurance expense

4 points

Question 11

Mandates are

directives

laws

regulations

standards

4 points

Question 12

Which type of HMO offers subscribers health care services by physicians who remain in their individual office setting?

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