RMA Insurance and Reimbursement 3

Question 1

What does a 'deductible' represent in a health insurance plan?

Accepted Answer

The amount a patient must pay before insurance begins to pay

Answer

The deductible is the amount the patient pays out of pocket before benefits kick in.

Question 2

A 'copayment' is best described as:

Accepted Answer

A fixed dollar amount paid at the time of service

Answer

A copay is a set flat fee the patient pays for a covered service at the visit.

Question 3

What is 'coinsurance'?

Accepted Answer

A percentage of allowed charges the patient pays after the deductible

Answer

Coinsurance is the percentage share of costs a patient pays once the deductible is met.

Question 4

What is the purpose of 'precertification' (prior authorization)?

Accepted Answer

To obtain insurer approval before a service is performed

Answer

Precertification confirms the insurer will cover a planned service before it is rendered.

Question 5

When a claim is denied for 'lack of medical necessity,' the medical assistant should first:

Accepted Answer

Review documentation and consider filing an appeal

Answer

Reviewing supporting documentation and appealing is the appropriate first step for such denials.

RMA Practice Test