Employee name:
Employee ID
Training start date: Training end date:
Grade:
Multiple choice: For each of the following questions, circle the letter of the answer or fill in the blank if needed.
- Who is entitled to Medicare?
A. ESRD (End Stage Renal Disease)
B. Disability
C. Age 65 or older
D. None of the above
E. All of the above
F. Other: ______
- Who is primary on Medicare?
A. Spouse
B. Patient
C. Child
D. Other: ______
3. What is MSP (Medicare Secondary Payer)?
A. Medicare Supplement (Medigap)
B. Questionnaire used to identify other payers that may be primary to Medicare
C. Workers Compensation
D. Other: ______
4. What does HMO stand for?
A. Hospital Management Organization
B. Hospital Medical Organization
C. Health Maintenance Organization
D. Other: ______
5. If a patient is presenting for ER services and has a Florida Medicaid policy, what plan code would you register it under?
A. 200100
B. 120200
C. 120400
D. Self pay
E. Other: ______
6. On which registration screen are accident/liability details entered?
A. Physician page
B. Insurance page
C. Medical page
D. Misc. page
E. Other: ______
True or False: For each statement, circle True or False.
True / False / 1. The Medicare Part A deductible for 2008 is $992.00True / False / 2. The Medicare Part B deductible for 2008 is $135.00
True / False / 3. All Medicare supplement plan codes begin with 150
True / False / 4. It is acceptable to read back a patient’s information if the patient has presented before in the emergency room
True / False / 5. Medicare Part A covers outpatient services
True / False / 6. The card control number on a Florida Medicaid card is the actual patient ID
True / False / 7. If RTE is down for maintenance it is acceptable to leave an insurance policy without verification
True / False / 8. The Emergency Room self-pay rate is $325.00
True / False / 9. All Medicare patients require authorization for emergency procedures
True / False / 10. Medical Necessity is checked for patients presenting with Medicare in the Emergency Room
Fill in the blank: Into each sentence below, copy a term from the word bank that correctly completes the sentence.
PPO / MSP / EMTALA / RTE / Availity591006663 / PFFS / $325.00 / 150
1. Relay Health is also known as: RTE
2. Completing this form on the insurance page for Medicare patients helps to identify who the primary payor is: MSP
3. Preferred provider organization PPO
4. BRCH Provider ID 591006663
5. Medicare supplement plan codes always begin with: 150
6. Private Fee For Service PFFS
7. ER self-pay rate is what amount? $325.00
8. Web site that enables healthcare providers’ access to benefit verification and authorizations. AVAILITY
9. Any patient who “comes to the emergency room dept” requesting “examination of treatment for a medical condition” must be provided with an “appropriate medical screening examination,” to determine if he or she is suffering from an “emergency medical condition.” This regulatory provision is also knows as: EMTALA (Emergency Treatment and Labor Act)
Please list the four essential elements when registering a Medicare patient in the ER
1. Patient and/or Spouse Retirement/Entitlement Date(s)
2. Completion of MSP questionnaire
3. RTE Relay Health electronic verification of policy.
4. Occurrence Code(s)
Essay question: Please explain the type of documentation that is required when registering Workers Compensation:
Accident date, Accident time. Where accident occurred, how the accident occurred, Workers Compensation name, Workers Compensation address, Workers Compensation telephone number, Claim adjuster name and Claim #, Patient place of employer at time of accident, Manager or Supervisor name who took report.
1) Which plan code would you choose? Please circle your answer
1. 735199 PPO/PPC/PHS/Traditional
2. 735299 Health Options
3. 735399 BC/BS Network Blue
4. 735501 BC/BS Medicare HMO
5. 735510 BC/BS Medicare PFFS
6. 735520 BC/BS Medicare PPO N/C
2) Which plan code would you choose? Please circle your answer
1. 755100 Cigna Healthcare PPO/Select
2. 755200 Cigna Healthcare HMO
3. 755500 Cigna Medicare HMO N/C
4. 755510 Cigna Medicare PFFS
3) Which plan code would you choose? Please circle your answer
1. 830200 Vista HMO (Formerly HIP)
2. 830400 Buena Vista Medicaid HMO N/C
3. 830500 Vista Medicare Replacement HMO
4. 830510 Vista Medicare Replacement PFFS
4) Which plan code would you choose? Please circle your answer
1. 710100 First Health Direct/CCN/Coventry PPO
2. 710722 First Health Network (Not London, KY ADD)
3. 710119 Mail handlers Benefits Plan
4. 710121 Southcare PPO
5. 710125 MegaLife
6. 710130 Global Care Inc
7. 710135 Mid-West
8. 710200 Coventry HMO
9. Other: ______
5) Which plan code would you choose?
None. Boca Raton Community Hospital does not accept “Rebate”, “Warranty” cards
6) Which plan code would you choose?
861100
Employee Signature / Manager SignatureName:
Date: / Name:
Date:
Editor’s note: This is the assessment test new access staff members at Boca Raton (FL) Community Hospital take after their four-day training program. The answers to each question are in red.