MEDICAL ASSISTANT CLASS Chapter 17 Medical Insurance 1. The...

Question MEDICAL ASSISTANT CLASS Chapter 17 Medical Insurance 1. The… MEDICAL ASSISTANT CLASSChapter 17 Medical Insurance 1. The __________________________ is a doctor chosen by the patient who is the first doctor thepatient sees and is responsible for making referrals for further treatment by a specialist orhospitalization.2. A _____________________________ allows the enrollee to have the freedom to obtain medicalcare from an HMO provider or to self-refer to a non-HMO provider at a greater cost.3. The ____________________________ was developed using values for each medical and surgicalprocedure based on work, practice, and malpractice costs and factoring in the regionaldifferences.4. ___________________________ is prior notice and approval that need to obtain beforeservices will be covered.5. A _________________________ is an organization of providers who network together to offerdiscounts to purchasers of health care insurance.6. The _______________________ is a specific time during which benefits will be paid undercertain type of health insurance coverage.7. The amount provider writes off the patient’s account is known as an ______________________.8. ___________________________ is prescription drug coverage.9. Pleas list three examples of insurance fraud and three examples of insurance abuse.a. Fraud: __________________________________________________________________________________________________________________________________________b. Abuse: ____________________________________________________________________________________________________________________________________________10. Match the statements below with the appropriate Medicare part.____1. Covers outpatient expenses including providers’ A. Medicare Part Afees, labs, tests, and radiologic studies.____2. Covers hospital admission and stays B. Medicare Part B____3. Offers prescription coverage C. Medicare Part C____4 . Referred to as Medicare advantage plan D. Medicare Part D____5. Does not require a monthly premium____6. Has a “donut hole” or coverage gap____7. Will start paying for services after a $198deductible has been met____8. Requires a monthly premium____9. Covers hospice care____10 . Covers charges for durable medicalequipmentCase studyCalculating allowed chargers and patient responsibilityA new patient Carol Cooper, age 67, has just received services at the family practice clinic where youwork. Her charges for the day came to $200.00. She is a Medicare beneficiary with no secondarycoverage. Your practice is a participating provider with Medicare and accepts assignments, whichallow $100 for the service. You have already contacted Medicare and verified that her Medicaredeductible responsibility has been already met and that her services are covered.Please calculate what Medicare will potentially pay for her services. Fill in the appropriate amount.A. New patient visit charge _____________________B. Allowed amount for the service according to the Medicare’s fee schedule _______________80% to be paid by Medicare __________________________Amount to be written off by the provider __________________________Patient responsibility __________________________ Health Science Science Nursing BIO 166551 Share QuestionEmailCopy link Comments (0)