Certified Billing and Coding Specialist - Mock Exam 1 (2022) COMPLETE SOLUTIONS

All are eligible under Medicare health insurance except: a) retiree of the Civil Service Retirement System b) persons of 65 years or older, retired on Social Security benefits c) those diagnosed with end-stage renal disease (ESRD) d) All kidney donors - d) All kidney donors Which provider/network must accept the payer's allowable amount as 100% payment for procedures or services provided? a) Out of Network provider b) Participating provider c) Non-participating provider d) Both a & b - b) Participating provider _____ means the provider agrees to accept what the insurance company approves as payment in full for the claim. a) Assignment of benefits b) Fee schedule c) accept assignment d) Capitation - c) accept assignment Charge a higher premium than HMO's in exchange for more flexibility and more options for the beneficiaries. There is no gatekeeper-physician and beneficiaries choose the provider from whom to seek services as long as the provider is within the network. a) PPO b) HMO c) Triple Plan Option