Why must a provider obtain an NPI number?
I. To submit claims
II. To prove that he is licensed
III. To be HIPAA compliant
IV. To guarantee payment by a health plan
a. I, II, III
b. II, III, IV
c. I, II, III, IV
d. I, III - ANSWERSd. I, III
A patient has receipts for her dental cleaning...
Why must a provider obtain an NPI number?
I. To submit claims
II. To prove that he is licensed
III. To be HIPAA compliant
IV. To guarantee payment by a health plan
a. I, II, III
b. II, III, IV
c. I, II, III, IV
d. I, III - ANSWERSd. I, III
A patient has receipts for her dental cleaning, vision exam, and contact lenses. Her
employer has set up special accounts for each employee, there is no limit to the amount
the employer can contribute and the balances roll over from year to year. What type of
account is this?
a. Flexible Spending Account (FSA)
b. Health Savings Account (HSA)
c. Health Insurance Account (HIA)
d. Traditional Healthcare Reimbursement Arrangement (HRA) - ANSWERSd.
Traditional Healthcare Reimbursement Arrangement (HRA)
A patient presents to be seen in the office. He does not pay at the time the services are
rendered as the provider is his primary care provider, or gatekeeper. The large group
practice has 800 covered members under this plan as is paid on a monthly basis with a
set amount that is based on the number of members covered and their ages. What type
of plan is this?
a. PPO
b. Capitation
c. Fee-for-service
d. Indemnity - ANSWERSb. Capitation
(Capitation payments are used by managed care organizations (MCOs) to control
healthcare costs by putting the physicians at financial risk for services provided to
patients. Payments are based on a per-person rate, rather than a fee-for-service rate.)
A family practitioner sees a Medicare patient and bills a 99213. This provider has opted-
out of Medicare. His fee for the service is $125.00. Medicare's approved amount is
, $73.08, and the patient has met $0 of his deductible. What can the provider bill the
patient?
a. $125.00
b. $73.08
c. $14.62
d. $58.46 - ANSWERSa. $125.00
(Providers that opt-out of Medicare are not limited to any specific charge limit on their
patients. The patient is responsible for payment in full for services as Medicare will not
pay any amount to either the patient or provider in this situation.)
What are the options for a provider with regards to participation with Medicare?
a. It is mandatory for every provider to participate in Medicare
b. Providers may participate, may choose not to participate, or may opt-out of Medicare
c. Providers are automatically opted-out
d. Only participating providers must file claims - ANSWERSb. Providers may participate,
may choose not to participate, or may opt-out of Medicare
Which insurance is a healthcare benefit program for military personnel in all seven
uniformed branches?
a. Medicare
b. Medicaid
c. TRICARE
d. BCBS - ANSWERSc. TRICARE
A Medicaid patient presents for services on the first day of the month. He has a $50
spenddown and has had no services this month. The visit for today was $100.00. If the
patient wants to be covered as long as possible from today's visit, what can he do?
a. Turn the receipt in to his caseworker and be eligible for two months of coverage
b. Turn the receipt in to his caseworker and be eligible for the month with $50 to
assessed by Medicaid for the visit that is above his spenddown
c. Coverage is automatic and the patient will be reimbursed the $100 from Medicaid
d. Turn in the receipt to his caseworker and be eligible for coverage for the current
month, plus two additional months - ANSWERSa. Turn the receipt in to his caseworker
and be eligible for two months of coverage
(A bill that is larger than the spenddown may be used to meet multiple month's
spenddown. If a patient wants the most coverage possible, $100 would meet two
month's coverage spenddown.)
An internist sees a 20-year-old patient for an office visit. The patient needs to see an
endocrinologist for a consultation regarding her diabetes. The internist is a participating
provider in her plan. She can choose any provider she wishes for her consultations, but
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