BCBS Exam Questions and Answers

Blue Cross Blue Shield began as two separate __________ health plans - THE CORRECT ANSWER IS prepaid In ______ the membership of the separate BCBS national associations voted to combine personnel under the leadership ...

Blue Cross Blue Shield began as two separate __________ health plans - THE CORRECT ANSWER IS prepaid In ______ the membership of the separate BCBS national associations voted to combine personnel under the leadership of a single president - THE CORRECT ANSWER IS 1977 In ______ BCBS merged into a single coproration - THE CORRECT ANSWER IS 1986 __________ corporations are charitable, educational, civic or humanitarian organizations whose profits are returned to the program of the corporation rather than distributed to shareholders and officers of the corporation - THE CORRECT ANSWER IS non-profit ______ corporations pay taxes on profits generated by the corporations enterprises and pay dividends to shareholders on after-tax profits - THE CORRECT ANSWER IS for-profit BSBS is responsible for: - THE CORRECT ANSWER IS * making prompt, direct payments * provide representatives to assist providers with claim problems/questions * provide educational seminars, workshops * provide billing manuals, newsletters * publish a directory of PAR's for BCBS subscribers PAR - THE CORRECT ANSWER IS Participating Provider - healthcare provider who enters into a contract with a BCBS corporation BCBS programs include the following: - THE CORRECT ANSWER IS * Fee-for-service * Indemnity * Managed care plans * Federal Employee Program * Medicare supplemental plans * Healthcare Anywhere __________________ plan are normally selected by individuals who do not have access to a group plan or are a small business with many employees - THE CORRECT ANSWER IS Fee-for-service BCBS Basic coverage includes: - THE CORRECT ANSWER IS * Hospitalization * Diagnostic laboratory services * X-rays * Surgical fees * Assistant surgical fees * Obstetric care * Intensive care * Newborn care * Chemotherapy for cancer Medical emergency care rider includes ________________________ - THE CORRECT ANSWER IS emergency services _________________ is a healthcare delivery system that provides health care and controls costs through a network of physicians, hospitals, and other healthcare providers - THE CORRECT ANSWER IS managed care The coordinated home health and hospice care program allows patients with this option to elect an alternative to the ____________ setting - THE CORRECT ANSWER IS acute care EPO - THE CORRECT ANSWER IS Exclusive Provider Organization The outpatient pretreatment authorization plan OPAP, requires preauthorization of outpatient physical, occupational, and speech therapy services; also called - THE CORRECT ANSWER IS prospective authorization or precertification BSBC calls policyholders - THE CORRECT ANSWER IS members Is BSBC the only insurance for Federal Employees - THE CORRECT ANSWER IS No The members name is the only name on the BCBS car - THE CORRECT ANSWER IS True The three digit code on the bottom left of the BCBS FEP card is known as the - THE CORRECT ANSWER IS enrollment code ________ plans pay for Medicare deductibles and copayments (supplemental or secondary insurance) - THE CORRECT ANSWER IS Medigap What plans are primary over Medicare plans - THE CORRECT ANSWER IS Group On claim forms you should re-file no later than _______ after it is received back - THE CORRECT ANSWER IS 30 days UCR - THE CORRECT ANSWER IS Usual, Customary, Reasonable a protection from cancellation of policy that would need to be signed is a ____________________ clause - THE CORRECT ANSWER IS non-cancellation Members have to sign a ___________________________ form annualy - THE CORRECT ANSWER IS release of information an EOB is also called ______________________ - THE CORRECT ANSWER IS Remittance advice A student has to sign a for saying their a full time student _________________________ - THE CORRECT ANSWER IS every semester A plan that is first subscribed to the member is called a - THE CORRECT ANSWER IS home plan If you go outside of your network the member is responsible for ______% of the payment - THE CORRECT ANSWER IS 100 Blue Cross plans originally covered only - THE CORRECT ANSWER IS hospital bills Blue Shield plans originally only covered fees for - THE CORRECT ANSWER IS physician services Secondary insurance plans provide coverage similar to that of - THE CORRECT ANSWER IS primary plans Any changes in benefits for BCBS members needs to be approved by the - THE CORRECT ANSWER IS state insurance commisioners __________________ coverage is flexible and has more freedom to members; coverage includes hospital only or comprehensive hospital and medical coverage; do not have a pcp, no referral needed - THE CORRECT ANSWER IS indemnity Where was the first known plan formed - THE CORRECT ANSWER IS Palo Alt, California The year American Hospital Association adopted the blue cross symbol - THE CORRECT ANSWER IS 1939 BCBSA in Chicago performs the following functions: - THE CORRECT ANSWER IS * Establishes standards for new plans and programs * Assists local plans with enrollment activities, national advertising, public education, professional relations,and statistical and research activities. * Serves as the primary contractor for processing Medicare hospital, hospice and home healthcare claims *Coordinates nationwide BCBS plans Policies issued by the nonprofit entity can be canceled, or an individual unenrolled only: - THE CORRECT ANSWER IS * when premiums are not paid * if the plan can prove that fraudulent statements were made on the application for coverage PAR providers agree to: - THE CORRECT ANSWER IS * Submit insurance claims for all BCBS subscribers * Write-off differences of allowed and billed * bill patients for only the deductible and copay/coinsurance amounts BCBS major medical coverage covers: - THE CORRECT ANSWER IS * Office visits * Outpatient nonsurgical treatment * Physical and occupational therapy * Purchase of DME (durable medical equipment) * Mental health visits * Allergy testing/injections * Prescription drugs * Private duty nurses * Dental Care