Sutter - Day7 -Quizz

What is IPA?

• International Patient Administration

• Independent Practice Association

• International Practice association

• Individual Practice association

What is DOFR?

• Diversion of Financial Responsibility

• Dept of Financial Responsibility

• Division of federal Rule

• Division of Financial Responsibility

DOFR models aim is to provide better care at higher cost

• True

• False

IPA allows a physician to work individually as well as in a group.

• True

• False

Medical Group usually works

• independently

• in a geographical area

• with PPO network

• in a group

The charges covered under (DOFR) depend on the specific contract between a Medical Group/IPA and a health plan or payer

• False

• True

As per DOFR, reason code 109 denial code indicates that claim should be billed to only Health Plan ?

• True

• False

As per DOFR, reason code- PR 96 is

• A service provided is not covered under the DOFR,

• Payer Responsibility

• Non covered as per Provider contract

• Non- covered as per contract between provider and payer

As per DOFR, RC - B11 is

• Capitation denial

• ABN is not signed

• COB needs to be updated

• The claim/service has been transferred to the proper payer/processor for processing

DOFR denial is only for Medicare insurance

• False

• True