Chapter 3: Introduction to Revenue Management

Which means the provider agrees to accept what the insurance company allows or approves as payment in full for the claim?

• accept assignment

• assignment of benefits

Health insurance plans may include a(n) ________ provision, which means that when the patient has reached that limit for the year, appropriate patient reimbursement to the provider is determined.

• assignment of benefits

• coinsurance and copayment

• accept assignment

• out-of-pocket payment

Which person is responsible for paying the charges?

• enrollee

• guarantor

• patient

• payer

A participating provider (PAR) contracts with a health insurance plan and accepts whatever the plan pays for procedures or services performed. This means that PARs __________ allowed to bill patients for the difference.

• are not

• are sometimes

• are always

• are usually

Between the contracted rate and their normal fee.

• are

• are not

Tags

NGSS.HS-ESS3-2

NGSS.HS-ETS1-3

A nonparticipating provider (nonPAR) is an out-of-network provider who does not contract with the insurance plan, and patients who elect to receive care from non-PARs will incur higher out-of-pocket expenses. The patient ________ expected to pay the difference between the insurance payment and the provider’s fee.

• is not

• is usually

Dr. Smith is a participating provider (PAR) for the ABC Health Insurance Plan. Mary Talley is treated by Dr. Smith in the office, for which a $100 fee is charged. Given the information in the table located below, calculate the PAR provider write-off amount.

• $10

• $20

• $30

• $40

Dr. Jones is a nonparticipating provider (nonPAR) for the ABC Health Insurance Plan. Anne Smith is treated by Dr. Jones in the office, for which a $100 fee is charged. Given the information in the table located below, calculate the nonPAR provider write-off amount.

• $0

• $10

• $20

• $30

Which is the insurance plan responsible for paying health care insurance claims first?

• primary insurance

• secondary insurance

• supplemental insurance

• tertiary insurance

When a child lives with both parents, and each parent subscribes to a different health insurance plan, the primary and secondary policies are determined by applying the birthday rule. The individual who holds the primary policy for dependent children is the spouse whose birth __________.

• day occurs earlier in the month

• month and day occur earlier in the calendar year

• month, day, and year occur earlier

• year occurs earlier