Revenue Cycle Management Ch.13
BlueCross BlueShield Exam Questions With
Correct Answers.
One of the requirements that a participating provider must comply with is to
a. purchase billing manuals and newsletters published by the payer and pay registration fees to
attend payer training sessions.
...
One of the requirements that a participating provider must comply with is to
a. purchase billing manuals and newsletters published by the payer and pay registration fees to
attend payer training sessions.
b. make fee adjustments for the difference between amounts charged to patients for services
provided and payer-approved fees.
c. maintain a provider representative department to assist with billing and payment problems for
submitted claims.
d. write off deductible and copay/coinsurance amounts and accept as payment in full the BCBS-
allowed fees. - answer✔✔make fee adjustments for the difference between amounts charged to
patients for services provided and payer-approved fees.
Which is a program that requires providers to adhere to managed care provisions?
a. indemnity
b. traditional coverage
c. fee-for-service
d. preferred provider network - answer✔✔preferred provider network
One of the expectations that a nonparticipating provider has is to _____ for services rendered.
a. obtain payment for the full fee charged
b. waive patient deductibles and copay/coinsurance
c. file the CMS-1500 claim on behalf of the patient
d. receive reimbursement directly from the payer - answer✔✔obtain payment for the full fee
charged
Which is considered a minimum benefit under BCBS basic coverage?
a. prescription drugs
b. physical therapy
c. office visits
d. hospitalizations - answer✔✔hospitalizations
Which is considered a service reimbursed by BCBS major medical coverage?
a. mental health visits
b. diagnostic laboratory services
c. chemotherapy for cancer
d. assistant surgeon fees - answer✔✔mental health visits
Which is a special clause in an insurance contract that stipulates additional coverage over and
above the standard contract?
a. copayment
b. coinsurance
c. rider
d. deductible - answer✔✔rider
BCBS indemnity coverage is characterized by certain limitations, including
a. provision of care by participating licensed health care providers.
b. the requirement that patients obtain a referral before seeing a provider.
c. the requirement that patients identify and select a primary care provider.
d. hospital-only or comprehensive hospital and medical coverage. - answer✔✔hospital-only or
comprehensive hospital and medical coverage.
Prospective authorization or precertification is a requirement of the _____ BCBS managed care
plan.
a. outpatient pretreatment authorization
b. point-of-service
c. second surgical opinion
d. coordinated home health and hospice care - answer✔✔outpatient pretreatment authorization
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