Claims to a commerical insurance company?

Question

You work in a physician's office and have just submitted several claims to a commerical insurance company. Your office will probably be reimbursed based on a

A. Prospective payment system

B. Resource-based relative value scale

C. Traditional fee-for-service system

D. Resource utilization group decison.

Answer 1

In most cases, B is the correct answer.  I found this link from Wikipedia to be most helpful.  I used to work in medical business offices as a consultant, but that has been several years ago.  But this is the answer that made the most sense to me.  Good luck...

Answer 2

C.

Choice A - Prospective Payment System (PPS) describes how Medicare reimburses hospital and other inpatient claims.

Choice B - Resource-Based Relative Value Scale (RBRVS) is  part of the Medicare physician reimbursement methodology.  (Some HMOs use it too, but its primarily a Medicare thing.)

Choice D is a made-up choice, as far as I know.  (I've worked in nearly every type of health care or insurance setting, and I haven't heard of that exact phrase...it almost sounds like they were trying to trick you into thinking it was Resource Group Utilization (RUG) which was how skilled nursing facilities were reimbursed by Medicare.)

Choice A & D don't even apply to physician offices.  And Choice C is far more likely to be used by a regular commercial insurance company (versus a managed care organization)

Answer 3

C makes the most sense to me. The term "fee for service" is thrown around a lot in medical offices. I haven't heard of the others.

Answer 4

hmmmm