4 Written Questions

1. the cost of medical malpractice insurance. Medical malpractice insurance that covers the insured only for those claims made while the policy is in force is called claims-made coverage.
2. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.
3. UCR method is used mostly in reference to fee-for-service reimbursement. To arrive at a payment amount for a claim, the carrier compares Usual, Customary, Reasonable charges.
4. The actual charge submitted on a claim ( must be reasonable to the provider) The lowest amount is used as the basis for payment ( the allowable charge)

4 Multiple Choice Questions

1. practice costs related to the performing the service.
   1. RBRVS: Malpractice
   2. RBRVS: Work
   3. RBRVS: Overhead
   4. Reasonable
2. Under this schedule, a procedure's relative value is the sum total of three elements. Work, Overhead, Malpractice. Payments are determined by multiplying a code's relative value by a constant dollar amount called a conversion factor( Multiplier)
   1. Contracted Rates with MCO's
   2. Medicare's Resource Based Value Scale Payment Shedule (RBRVS)
   3. Relataive Value Payment Schedules Method
   4. Medicare conversion factors
3. The physician's most frequent charge for a given service.
   1. Usual
   2. Customary
   3. Reasonable
   4. RBRVS: Work
4. The average charge of all providers of simular training and experience in a given geographical area.
   1. Usual
   2. RBRVS: Work
   3. Reasonable
   4. Customary

4 True/False Questions

1. Capitated Rates → The average charge of all providers of simular training and experience in a given geographical area.

   True        False

2. Medicare conversion factors → conversion factors are determined annually be the CMS in cooperation with Congress. Conversion factor varies according to the type of service provided.

   True        False

3. Relataive Value Payment Schedules Method → Use of relative value scales which assign a relative weight to individual services according to the basis of the scale. Services that are more difficult, time consuming, or resource intensive to perform typically have higher relative value than other services.

   True        False

4. RBRVS: Work → practice costs related to the performing the service.

   True        False