22A thirdparty subrogation.
, A .L m - .93 Li \
9A k- ~ A
w .r. a.:.l mu
18. After suffering an industrial injury, Mr. Fields is in a treatment program in which
he is given real work tasks for building strength and endimce-
3: ASSEGNMENT 12-2 CALCULATE MATHEMAT!CAL PROBLEMS
Task: Calculate and insert the correct amounts for sever; Medicare scenarios.
Conditions: Use a pen or pencil, cfw_he description cf problem, and, for Problem 7, Figures 321
12. Acceptance of assignment by a participating physician means that be or she agrees to
W aft r the s 55
annual deducti e has been met. VLS Wmi fbm POOH enl
13. Philip Lenz is seen by Dr. Doe, who schedules an operative procedure in 1 month.
This type of
@siGNMET 15-1 REVIEW QUES'HONS
Part E Fin in the Biank
Review the objectives key terms. glossary denitions of key terms, shapter information
and gures before compieting the foilowing review questions
1. Name two kinds of statutes under workers compensaiio
it When an employee with a preexisting condition IS injured at work and the injury
produces a disability Greater than what would have been caused by the secend injury
lone, the benets are derived from alan
12. What is the minimum number of employe
'1. If a physician or hospital in a managed care plan is paid a xed, per capita amount
: 4. The oldest type ofthe prepaid heaitii pians is e ' ' NUS)
5. Name four types of health maintenance organization (HMO) models.
7. Name two types of operations use
12 RITRICARE Standard, retired members or their dependenrs pay what percentage for
outlier: services, after the deductible has been met? M
W pacemage does TRICARE pay? b.
13. A why TRJCARE heaIth maintenance organization type of option is known as
a. HCPCS Code 47600: Removal of gallbladder. The medicai practice is 1oc3edin Phoenix, Arizona.
Work Overhead Makimctice
RVUS [0 56D LL91 3 Lab
GPCI LLDDA. .01 Lo x )3. 55;
+M ernLLQ3_= TotaladjlmedRVUs
e. To zero out the baiance, the Medicare courtesy adjustment is
ans fee is $1250. This patient is
Problem 6: Mrs. Smith, a Medicare petient, had surgery, and the participating physici
00, applied $500 to the deduct-
19. When a Medicaid patient'requires a piece of durable 20. Medicare beneciaries who are disabled but have
medical equipment, the physician must annual incomes below the federal poverty level may
a. write a prescription be eligible for
@ obtain ptior auth
Part ill TruelFalse , , ,
Write T or F in the blank to indicate wether you think the statement is true or faise.
. The rst thing an employee should do alter be or she is injured on the job is to notify his or her employer
or immediate superv