If an HMO patient needs to return to a specialist for a follow up visit, is it necessary to obtain a  new referral?

                   a.  No

                    b.  Yes, if the first referral covers only one visit

                    c.  It depends on the date of service

 

Larry Smith, Jr. has insurance through his mother and father.  His mother has Blue Shield and his father has Aetna.  His mother's birth date is August 17, 1959 and his father's birth date is December 2, 1954.  Which insurance would be primary for  Larry Smith, Jr.?

                    a.  Mother's Insurance - Blue Shield

                    b.  Father's Insurance - Aetna

                    c. Neither

 

Which of the following are needed when billing services related to workers compensation or a motor vehicle accident?

                    a.  Policy Number

                    b. Claim Number

                    c. Date of Accident

                    d.  both b and c

 

True or False:  If Medicare applies the deductible to the patient's charges, you should not bill the secondary carrier for the balance.  False.

 

What services are included in the payment for a surgical service under the concept of Medicare's global surgical package?

                    a.  Pre-operative

                    b.  Post-operative

                    c.  A and B

                    d.  Pre-, intra-, and post-operative

 

You are a claims processor for an HMO insurance carrier.  You receive a claim from a cardiologist for a visit rendered to a plan member.  What additional information should you look for before authorizing payment?   A referral.