Medical Insurance 7e-A Revenue Cycle Process Approach Questions With Correct Answers Graded A+

Co-payment - An amount that an insured person pays at the time of a visit to a provider primary care physician- pcp - The physician responsible for directing all of a patient's medical care and determining whether the patient should be referred for specialty care-also known as a gatekeeper In an HMO with a gatekeeper system, ______ coordinates the patients care and provides referrals. - PCP Health plans pay for _____ services - covered In an HMO, securing _____ may be required before services are provided. - preauthorization Coinsurance is calculated based on - a percentage of a charge What rules apply when the patient needs to be admitted to the hospital? -patient must receive approval-obtain certification-7 days in advance of scheduled surgery of hospital admissions & within 48 hrs after emergency admissions-or 1st business day following wked or holiday emergency admissions. The patient's health plan has a $100 annual deductible. At the 1st visit of the year, the charges are $95. What does the patient owe? - $95 The patient's coinsurance percentage is stated as 75-25 in the insurance policy. The deductible for the year has been met. If the visit charges are a $1000, what payment should the medical insurance specialist expect from the payer? What amount will the patient be billed? - $250- $1000×25%=$250The patient's coinsurance percentage is stated as 80-20 in the insurance policy. The deductible for the year has been met. If the visit charges are $420, what payment should the medical insurance specialist expect from the payer? What amount will the patient be billed? - $84-$420×20%=$84