Exam (elaborations)
Medical Insurance Billing & Coding - Cma Exam Questions And Answers Well Elaborated
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Medical Insurance Billing & Coding - Cma Exam Questions And Answers Well Elaborated
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Medical Insurance Billing & Coding -Cma Exam Questions And Answers Well
Elaborated
-EOMB
-EPSDT
-LOS
-PF
-SOF
-UR - ANSWER✔✔*EOMB* - explanation of medicare benefits
*EPSDT* - early & periodic screening, diagnosis, and treatment
*LOS* - length of stay
*PF* - problem focused
*SOF* - signature on file
*UR* - utilization review
fiscal agent - ANSWER✔✔company the process insurance claims on behalf of the
insurance
formulary - ANSWER✔✔list of covered meds
RBRVS - ANSWER✔✔used by medicare to determine fee schedule for medicare
PartB
UCR - ANSWER✔✔*usual* - usual fee charges for service
*customary* - fee charged by doctors in the same area and specialty
, *reasonable* - fee changed based on complicated services
*Managed Care Plans*
HMO - ANSWER✔✔*Health Maintenance Organization*
-doc works for the plan and refers to PAR doc
-patient has copay and must use PCP in network
*Managed Care Plans*
PPO - ANSWER✔✔*Preferred Provider Organization*
-patient can use in & out of network
-doc is rewarded for in network services
-patient has copay and deductible
*Managed Care Plans*
EPO - ANSWER✔✔*Exclusive Provider Network*
-In Network only, unless there's an emergency
-employer must contract only with EPO
*Managed Care Plans*
IPA - ANSWER✔✔*Independent Practice Association*
-Doc's in a group work independently
-Doc's are paid by patient
*Government Health Plans*
-Medicare
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