RMA Insurance and Reimbursement 2

Question 1

A patient has both Medicare and Medicaid. Which is considered the primary payer?

Accepted Answer

Medicare

Answer

Medicaid is always the payer of last resort, so Medicare pays first.

Question 2

What does the term 'coordination of benefits' (COB) refer to?

Accepted Answer

Determining the order in which multiple insurers pay

Answer

COB establishes which insurer is primary and which is secondary when a patient has more than one plan.

Question 3

Under the 'birthday rule,' which parent's plan is primary for a dependent child?

Accepted Answer

The parent whose birthday falls earlier in the calendar year

Answer

The birthday rule makes primary the plan of the parent whose birthday comes first in the year.

Question 4

What is an Explanation of Benefits (EOB)?

Accepted Answer

A statement from the insurer detailing what was paid and patient responsibility

Answer

The EOB documents the insurer's processing of a claim, including payments and patient responsibility.

Question 5

A 'capitation' payment model reimburses a provider how?

Accepted Answer

A fixed amount per patient per month regardless of services

Answer

Capitation pays a set fee per enrolled patient per period, no matter how many services are used.

RMA Practice Test