Deductibles and Counters: Post Test

1.

1 point

Your instructor will give you a claim number. Questions 1 - 5 should be answered by looking at this claim in Facets. In your answers, use numbers and a decimal point. Do not add commas or dollar signs.

What is the claim’s billed charge?

2.

1 point

What is the claim's allowed charge?

3.

1 point

How much deductible was credited for the claim?

4.

1 point

How much copay did the patient have to pay?

5.

1 point

How much coinsurance did the patient have to pay?

6.

1 point

What do we call the amount that’s left over after all of the cost-sharing factors?

Deductible

Cost-sharing

Write-off

Disallow

Tough luck

7.

3 points

Select the three items from the list that are member cost-sharing factors on most medical insurance plans?

Deductible

Out-of-pocket maximum

Coinsurance

Copay

Write-off

8.

1 point

What is the definition of coinsurance?

It is a percent of allowed charges that a member has to pay.

It is the percent of allowed charges that insurance has to pay.

It is a flat fee that a member has to pay for certain services, and the amount can vary by in-and out-of-network among other factors.

It is the cost the provider absorbs, based on allowed charges.

It is the same thing as the deductible.

9.

1 point

True or False? To find out if a deductible should be applied towards a member's out-of-pocket maximum, you can check the plan information in the TriWiki.

True

False

10.

1 point

The allowed amount is

a set amount the member has to pay before most benefits can be paid.

a percent of the allowed amount the member pays.

a flat fee the member pays at the time of service.

the most a member will have to pay out-of-pocket for the year.

the contracted amount a provider has agreed to accept as payment in full for a procedure.

11.

1 point

The deductible is

a set amount the member has to pay before most benefits can be paid.

a percent of the allowed amount the member pays.

a flat fee the member pays at the time of service.

the most a member will have to pay out-of-pocket for the year.

the contracted amount a provider has agreed to accept as payment in full for a procedure.

12.

1 point

The coinsurance is

the most a member will have to pay out-of-pocket for the year.

the contracted amount a provider has agreed to accept as payment in full for a procedure.

a set amount the member has to pay before most benefits can be paid.

a percent of the allowed amount the member pays.

a flat fee the member pays at the time of service.

13.

1 point

The copay is

a set amount the member has to pay before most benefits can be paid.

a percent of the allowed amount the member pays.

a flat fee the member pays at the time of service.

the most a member will have to pay out-of-pocket for the year.

the contracted amount a provider has agreed to accept as payment in full for a procedure.

14.

1 point

The out-of-pocket maximum is

a set amount the member has to pay before most benefits can be paid.

a percent of the allowed amount the member pays.

a flat fee the member pays at the time of service.

the most a member will have to pay out-of-pocket for the year.

the contracted amount a provider has agreed to accept as payment in full for a procedure.

15.

1 point

True or false? Member cost-sharing factors include copay, co-insurancce and allowed charges.

True

False

16.

1 point

True or False? For the purpose to calculating member responsibility, you can ignore the billed amount.

True

False

17.

1 point

Which screen in the Facets Customer Service application do you look at to see the copays and coinsurance for a processed claim?

COB

Deductible

General

Limits

Medical or Hospital Claims Processing

18.

1 point

Which screen in the Facets Customer Service application do you look at to see the out-of-pocket benefits and the accumulations for a member?

COB

Deductible

General

Limits

Medical or Hospital Claims

19.

1 point

Whats is a "call limit?"

The number of visits a member has in excess of their allowed visits.

The number of times a member has had to pay a copay.

The number of visits a member can have to receive a certain service.

The amount a member must pay before most medical benefits are covered.

The amount of calling you're allowed before your cell phone bill goes up.

20.

1 point

True or false? It is possible for a member to have benefits paid for before they have met the individual deductible for themselves.

True

False