Revenue Cycle Management Ch.13 BlueCross BlueShield
Questions With Complete Solutions
A for-profit corporation pays taxes on:
a. dividends paid to shareholders resulting from for-profit
enterprises
b. dividends paid to shareholders resulting from nonprofit
enterprises
c. profits generated by the corporation's for-profit enterprises
d. profits generated by the corporation's nonprofit enterprises
Correct Answers profits generated by the corporation's for-
profit enterprises
A member hospital is one that has signed a contract to:
a. provide services for special rates
b. provide special services to members
c. require network membership of all providers
d. provide services to network members only Correct Answers
provide services for special rates
A PPN provider is one who has signed a PPN contract and
agrees to accept the PPN allowed rate, which is generally:
a. 100 percent of the PAR allowed rate
b. 10 percent lower than the PAR allowed rate
c. 100 percent of the nonPAR allowed rate
d. 10 percent higher than the PAR allowed rate Correct
Answers 10 percent lower than the PAR allowed rate
BCBS indemnity coverage is characterized by certain
limitations, including
, a. provision of care by participating licensed health care
providers.
b. the requirement that patients obtain a referral before seeing a
provider.
c. the requirement that patients identify and select a primary care
provider.
d. hospital-only or comprehensive hospital and medical
coverage. Correct Answers hospital-only or comprehensive
hospital and medical coverage.
BCBS payers currently accept what type of claim for physician
services?
a. CMS-1450
b. UB-92
c. UB-04
d. CMS-1500 Correct Answers CMS-1500
BCBS plans must obtain approval from their respective state
insurance commissioners for:
a. claims processing procedure changes
b. provider membership growth
c. rate changes
d. membership increases Correct Answers rate changes
Charitable, educational, civic, or humanitarian organizations
whose profits are returned to the program of the corporation
rather than to shareholders are called:
a. for-profit corporations
b. nonprofit corporations
c. managed care organizations
d. public corporations Correct Answers nonprofit corporations
Questions With Complete Solutions
A for-profit corporation pays taxes on:
a. dividends paid to shareholders resulting from for-profit
enterprises
b. dividends paid to shareholders resulting from nonprofit
enterprises
c. profits generated by the corporation's for-profit enterprises
d. profits generated by the corporation's nonprofit enterprises
Correct Answers profits generated by the corporation's for-
profit enterprises
A member hospital is one that has signed a contract to:
a. provide services for special rates
b. provide special services to members
c. require network membership of all providers
d. provide services to network members only Correct Answers
provide services for special rates
A PPN provider is one who has signed a PPN contract and
agrees to accept the PPN allowed rate, which is generally:
a. 100 percent of the PAR allowed rate
b. 10 percent lower than the PAR allowed rate
c. 100 percent of the nonPAR allowed rate
d. 10 percent higher than the PAR allowed rate Correct
Answers 10 percent lower than the PAR allowed rate
BCBS indemnity coverage is characterized by certain
limitations, including
, a. provision of care by participating licensed health care
providers.
b. the requirement that patients obtain a referral before seeing a
provider.
c. the requirement that patients identify and select a primary care
provider.
d. hospital-only or comprehensive hospital and medical
coverage. Correct Answers hospital-only or comprehensive
hospital and medical coverage.
BCBS payers currently accept what type of claim for physician
services?
a. CMS-1450
b. UB-92
c. UB-04
d. CMS-1500 Correct Answers CMS-1500
BCBS plans must obtain approval from their respective state
insurance commissioners for:
a. claims processing procedure changes
b. provider membership growth
c. rate changes
d. membership increases Correct Answers rate changes
Charitable, educational, civic, or humanitarian organizations
whose profits are returned to the program of the corporation
rather than to shareholders are called:
a. for-profit corporations
b. nonprofit corporations
c. managed care organizations
d. public corporations Correct Answers nonprofit corporations
