CPB - chapter 2 review Updated 2024/2025 Actual Questions and answers with complete solutions
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Course
CPB
Institution
CPB
A patient is scheduled in your office for Botox injections in her face for her smile lines. She has not met
her deductible and states that she is going to use money from her Healthcare Reimbursement Account
to pay for it. Is this possible?
a.
Yes, as long as she has enough money in the account,...
CPB - chapter 2 review A patient is scheduled in your office for Botox injections in her face for her smile lines. She has not met her deductible and states that she is going to use money from her Healthcare Reimbursement Account to pay for it. Is this possible? a. Yes, as long as she has enough money in the account, she may use it for any medical expense she chooses. b. No, cosmetic procedures are ineligible expenses. c. Yes, but only a portion since it is a cosmetic procedure. d. No, because a Healthcare Reimbursement Account cannot be used to meet a deductible. - b. No, cosmetic procedures are ineligible expenses A group contracts with a third party administrator to manage paperwork. This group pays for the operation of the insurance plan and the costs of administration. What type of plan does this represent? A. Fully Insured Employer Group B. Self - Funded ERISA C. Association Group D. Management Service Organization - B. Self - Funded ERISA Self-Funded ERISA - The group contracts with the insurance company or third -party administrator to handle the paperwork. This is available to large groups, which pays for the operation of the insurance plan itself and the costs for administration. A Medicare patient is seen in the Internist's office for a check -up. The office bills Medicare, but the patient receives the payment and the office must collect their fee from the patient. The office, by state law, can charge the patient a limiting charge that is 10 percent above the Medicare fee schedule amount. What type of Medicare provider is this physician? a. Non -limiting b. Opt-out c. Participating d. Non -participating - d.Non -participating A new patient is seen for a visit with a participating commercial carrier. Code 99204 is billed for $200. The contracted fee for this carrier is $153.35. The patient has a 20% co -pay after a $1000 deductible, of which $500 has been met. How much will the p atient owe? - $153.35 This is a participating physician and the contracted amount for this visit is $153.35. Since the deductible has not been met, the contracted amount will be applied toward the deductible and will be paid by the patient. A new physician comes into the practice that is just out of medical school. He will need to be able to see patients in the office and at the hospital. What process will he need to undergo in order to be able to participate with Medicare and other health pl ans? a. Credentialing b. Privileging c. Contract negotiations d. Board certification - a. Credentialing A healthcare organization with 2 hospitals, 20 clinics, and 3 urgent care centers belongs to an ACO program. They have been in the shared savings program for two years and are now eligible to move large
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