CCMA Exam 7 #1 Questions with correct answers
Advanced beneficiary notice - ✔✔A form provided to the patient hen the provider
believes medicare will probably not pay for services received
Allowed amount - ✔✔The maximum amount a third party payer will pay for a
particular procedure or service
Copayment - ✔✔An amount of money that is payed at the time of the service
Coinsurance - ✔✔A policy provision frequently found in medical insurance where
the policyholder and the insurance company share the cost of covered losses in a
specified ratio, ex: 80:20
Deductible - ✔✔A specific amount of money a patient must pay out of pocket
before the insurance carrier begins paying
Explanation of benefits - ✔✔A statement from the insurance carrier detailing
what was paid, denied, or reduced in payment; also contains information about
amounts applied to the deductible, coinsurance, and allowed amounts
Participating provider - ✔✔Providers who agree to write off the difference
between the amount charged by the provider and the approved fee established
by the insurer
Medicare - ✔✔generally covers patients age 65 and older by Part A
(hospitalization) or Part B (routine medical office visits) benefits
, Tricare - ✔✔authorizes dependents of military personnel to receive treatment
from civilian providers at the expense of the federal government
CHAMPVA - ✔✔covers surviving spouses and dependent children of veterans who
died as a result of service-related disabilities
Medicaid - ✔✔Provides health insurance to the medically indigent population
through a cost sharing program between federal and state governments for those
who meet specific eligibility criteria
Managed Care - ✔✔is an umbrella term for plans that provide health care in
return for preset scheduled payments and coordinated care through a defined
network of providers and hospitals
Workers Compensation - ✔✔protects wage earners against the loss of wages and
the cost of medical care resulting from an occupational accident or disease as
long as the employee is not proven negligent
CMS-1500 Form - ✔✔Used for claims submitted by a provider/supplier. The MA's
must have all information needed needed to complete the form including the
patient and guarantor's demographic and insurance information, diagnostic test,
treatment, or procedure information and billing information
Section one: carrier block
Section two: Patient/insured section
Section three: Physician/ supplier section - ✔✔Contains the address of the
insurance carrier and is located at the top of the form
Advanced beneficiary notice - ✔✔A form provided to the patient hen the provider
believes medicare will probably not pay for services received
Allowed amount - ✔✔The maximum amount a third party payer will pay for a
particular procedure or service
Copayment - ✔✔An amount of money that is payed at the time of the service
Coinsurance - ✔✔A policy provision frequently found in medical insurance where
the policyholder and the insurance company share the cost of covered losses in a
specified ratio, ex: 80:20
Deductible - ✔✔A specific amount of money a patient must pay out of pocket
before the insurance carrier begins paying
Explanation of benefits - ✔✔A statement from the insurance carrier detailing
what was paid, denied, or reduced in payment; also contains information about
amounts applied to the deductible, coinsurance, and allowed amounts
Participating provider - ✔✔Providers who agree to write off the difference
between the amount charged by the provider and the approved fee established
by the insurer
Medicare - ✔✔generally covers patients age 65 and older by Part A
(hospitalization) or Part B (routine medical office visits) benefits
, Tricare - ✔✔authorizes dependents of military personnel to receive treatment
from civilian providers at the expense of the federal government
CHAMPVA - ✔✔covers surviving spouses and dependent children of veterans who
died as a result of service-related disabilities
Medicaid - ✔✔Provides health insurance to the medically indigent population
through a cost sharing program between federal and state governments for those
who meet specific eligibility criteria
Managed Care - ✔✔is an umbrella term for plans that provide health care in
return for preset scheduled payments and coordinated care through a defined
network of providers and hospitals
Workers Compensation - ✔✔protects wage earners against the loss of wages and
the cost of medical care resulting from an occupational accident or disease as
long as the employee is not proven negligent
CMS-1500 Form - ✔✔Used for claims submitted by a provider/supplier. The MA's
must have all information needed needed to complete the form including the
patient and guarantor's demographic and insurance information, diagnostic test,
treatment, or procedure information and billing information
Section one: carrier block
Section two: Patient/insured section
Section three: Physician/ supplier section - ✔✔Contains the address of the
insurance carrier and is located at the top of the form
