Question

A patient has a PPO plan and would like to go to a specialist. Which form would the medical assistant use?

a) CMS-1500
b) UB-04
c) HIPAA release form
d) Referral form

Answer 1

For a patient with a PPO plan seeking to visit a specialist, the medical assistant would use a referral form, particularly if the plan requires it or if the specialist is out of network.

Step-by-step explanation:

If a patient with a PPO (Preferred Provider Organization) plan wishes to see a specialist, the medical assistant would likely use a referral form. This is because PPO plans typically allow patients to see in-network specialists without a referral, but if they choose to see an out-of-network specialist or if the plan has certain requirements, a referral from a primary care doctor might be necessary. Although the CMS-1500 form is used for billing, a UB-04 form is utilized for institutional billing, and a HIPAA release form is for authorizing the release of medical information, the correct document for initiating a visit to a specialist under a PPO plan would be the referral form when required.