Which is required of outpatient physical, occupational, and speech therapy services as part of an OPAP?
a. preadmission certification
b. precertification
c. preadmission testing
d. prospective review - precertification
Which phrase is located on a Federal Employee Program plan ID card?
a. Fam...
Revenue Cycle Management Ch.13
BlueCross BlueShield
Which is required of outpatient physical, occupational, and speech therapy services as part of an OPAP?
a. preadmission certification
b. precertification
c. preadmission testing
d. prospective review - precertification
Which phrase is located on a Federal Employee Program plan ID card?
a. Family, High Option Plan
b. Preferred Provider Organization
c. Office of Personnel Management
d. Government-Wide Service Benefit Plan - Government-Wide Service Benefit Plan
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 - preferred provider network
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. - make fee adjustments for the difference between amounts charged to patients for services
provided and payer-approved fees.
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 - 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 - 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 - 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 - rider
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