Physician fee amounts - Study guides, Class notes & Summaries

BESTQUIZZES COMPREHENSIVE EXIT EXAM – PRIORITY ONE 1. A nurse is assessing a client’s pulmonary artery wedge pressure (PAWP). The nurse should recognize that an elevated PAWP indicates which of the following complications? A. Left ventricular failure B. Cardiogenic shock C. Hypovolemia D. Hypotension 2. A nursing planning care for a school-age child who is 4 hr postoperative following perforated appendicitis. Which of the following actions should the nurse include in the plan ...

Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr. Brennan charge? correct answersDr. Brennan can charge Mary Rogers no more than the cost sharing specified in the PFFS plan's terms and condition of payment which may include balance billing up to 15% of the Medicare rate. Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an at...

AMCA CERTIFICATION TEST - MEDICAL ASSISTING STUDY GUIDE - SET A latest 20221) Which of the following is considered a parasitic infection? A. Lyme disease B. Rabies C. Ringworm D. Malaria ... 2) Aspirin and acetaminophen are examples of: A. Analgesics and antipyretics B. Antitussives and decongestants C. Antihistamines and antiemetics D. Antidotes and antibiotics ... 3) Demerol 75 mg, IM every 4 hours, as needed for severe pain, is what type of medication order? A. Single...

Modifiers - provide addtional info about the service/procedure indicating service/procedure has been altered but the definition of the code has not changed. Global Surgery Package - The time, effort, and services required to complete a procedure are bundled together to form a surgery package . Payment is made for a package of services and not each individual service provided within the package. Using RBRVS - CMS annually publishes Physician Fee Schedule information on its website and posts...

Calculate the following amounts for a participating provider who bills Medicare: Submitted charge (based on provider's regular fee for office visit)$ 75 Medicare physician fee schedule (PFS)$ 60 Coinsurance amount (paid by patient or supplemental insurance)$ 12 Medicare payment (80 percent of the allowed amount)$ ????? Medicare write-off (not to be paid by Medicare or the beneficiary)$ ????? - Medicare payment (80 percent of the allowed amount) $48 Medicare write-off (not to be paid by M...

What Act shaped how commercial insurance carriers approached the concepts of paying for medical care? - ANSWER-HMO Act of 1973 ACA - ANSWER-Affordable Care Act HMO (Health Maintenance Organization) - ANSWER-The organization is both the insurer and provider of a set of defined services. Patients within this network must use an in-network provider for their services to be covered. Capitation Payment - ANSWER-part of prospective payment in which healthcare providers receive fixed monthly p...

Medicare's payment amount for services are determined by which of the following formulas? a. Sustainable growth rate (SGR) X Geographic Practice Cost Index (GPCI) = Medicare payment b. Total RVU X Conversion factor = Medicare payment c. Total Practice Expense (PE) X Conversion factor = Medicare payment d. Total Malpractice insurance (MP) X Conversion factor (CF) = Medicare payment - b. Total RVU X Conversion factor = Medicare payment The total RVU is composed of which of the following ...

NCCT REVIEW-COLLECTIONS QUESTIONS AND ANSWERS 1. It is important to make the patient aware of the mailing address, interest rates, and length of agreement when setting up a A. fee schedule. B. payment arrangement. C. pre-payment plan. D. deductible fee. - Answer-payment arrangement. —-Rationale—- A payment arrangement is an agreement between the patient and medical office to make monthly payments on a balance that is the patient's responsibility. All the information will be on th...

Abuse - Actions inconsistent with accepted, sound medical business or fiscal practice Accept Assignment - Provider accepts as payment in full whatever is paid on the cliam by the payer (except for any copayment and or coinsurance amounts.) Accounts Receivable - The amount owed to a business for services or goods provided. Accounts Receivable Aging Report - Shows the status (by date) of outstanding claims from each payer, as well as payments due from patients. Accounts Receivable Management -...

NCCT REVIEW-COLLECTIONS QUESTIONSN AND ANSWERS 1. It is important to make the patient aware of the mailing address, interest rates, and length of agreement when setting up a A. fee schedule. B. payment arrangement. C. pre-payment plan. D. deductible fee. - Answer-payment arrangement. —-Rationale—- A payment arrangement is an agreement between the patient and medical office to make monthly payments on a balance that is the patient's responsibility. All the information will be on t...

Calculate the following amounts for a participating provider who bills Medicare: Submitted charge (based on provider's regular fee for office visit) $ 75 Medicare physician fee schedule (PFS) $ 60 Coinsurance amount (paid by patient or supplemental insurance) $ 12 Medicare payment (80 percent of the allowed amount) $ ????? Medicare write-off (not to be paid by Medicare or the beneficiary) $ ????? correct answer: Medicare payment (80 percent of the allowed amount) $48 Medicare write-...