HIM 1121 Medical Billing Practices Review || with 100% Accurate Solutions.
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Course
HIM 1121 Medical Billing Practices
Institution
HIM 1121 Medical Billing Practices
Calculate the amount of money a patient would owe for a noncovered service costing $900 if their indemnity policy has a coinsurance rate of 80-20, and they have already met their deductible correct answers $900
Calculate the monthly capitation payment a provider should receive from a health plan...
HIM 1121 Medical Billing Practices Review || with 100%
Accurate Solutions.
Calculate the amount of money a patient would owe for a noncovered service costing $900 if
their indemnity policy has a coinsurance rate of 80-20, and they have already met their
deductible correct answers $900
Calculate the monthly capitation payment a provider should receive from a health plan if they
have 80 contracted patients and a capitated payment of $40 per month correct answers The
monthly capitation payment would total $3,200 (80 x $40 = $3,200).
A capitated payment amount is called a correct answers prospective payment
Calculate the amount of money a patient would owe for a covered service costing $1,200 if their
indemnity policy has a coinsurance rate of 75-25, and they have already met their deductible.
correct answers The patient must pay an out-of-pocket expense of $300 ($1,200 x 0.25 = $300)
for this service.
A physician has a contract to receive a $2,000 monthly capitation fee, based on a fee of $50 for
40 patients who are in the plan. However, since only 10 patients visited the practice in the last
month, the capitation payment will be correct answers The monthly capitation fee is $2,000,
regardless of the number of patients who visit the physician.
Another term used for a primary care physician (PCP) is correct answers gatekeeper
Certification as a Certified Professional Coder (CPC) is awarded by correct answers AAPC
A patient ledger records: correct answers the patient's financial transactions
Calculate the amount of money the insurance company would owe on a covered service costing
$850 if there is a $500 deductible (which has not yet been met) and no coinsurance. correct
answers The health plan would owe $350 ($850 - $500 = $350).
Calculate the amount of money a patient would owe for a covered service costing $1,800 if their
indemnity policy has a $400 deductible (which has not been met) and their coinsurance rate is
80-20. correct answers The patient must pay an out-of-pocket expense of $680 ($1,800 - $400 =
$1,400; $1,400 x 0.20 = $280; $280 + $400 deductible = $680) for this service.
Identify the type of service that is not considered to be a preventive medical service. correct
answers outpatient surgery
Identify the type of HMO cost-containment method that requires patients to obtain approval for
services before they receive the treatment. correct answers requiring preauthorization for services
, Identify the advantages offered to patients in managed care plans, as compared to indemnity
insurance. correct answers lower premiums,charges, and deductibles
Healthcare claims report data to payers about __________ and __________. correct answers the
patient; the services provided by the physician
Identify the type of HMO cost-containment method that requires the patient to pay a copayment.
correct answers cost-sharing
Identify the type of HMO cost-containment method that requires providers to use a formulary.
correct answers controlling drug costs
Identify the type of HMO cost-containment method that limits members to receiving services
from the HMO's physician network. correct answers restricting patients' choice of providers
How is coinsurance defined? correct answers the percentage of each claim that the insured pays
Higher copayments may be charged for patient visits to/for: correct answers the office of a
specialist
identify another name for a point-of-service (POS) plan. correct answers open HMO
A ____________ is a person who makes an accusation of fraud or abuse. correct answers relator
A court order to appear and testify is a correct answers subpoena
A ____________ is an impermissible use or disclosure under the Privacy Rule that compromises
the security or privacy of PHI and also that could pose a significant risk of financial,
reputational, or other harm to the affected person. correct answers breach
A vendor such as a software firm that does business with a covered entity is called a(n) correct
answers business associate
A breach notification should include several pieces of information, including correct answers the
steps individuals should take to protect themselves from potential harm
a brief description of what happened
contact procedures for individuals to ask questions or learn additional information
A progress report documents a patient's correct answers Type of treatment still needed and
duration
A court order to appear, testify, and bring specified documents or items is a correct answers
subpoena duces tecum
A person's protected health information includes all of the following correct answers Address
Birth Date
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