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Week 2

Chapters 7,8,9,& 10

Cash flow is the ongoing availability of cash in the medical practice
When insurance carriers do not pay claims in a timely manner, what effect does it have on the medical practice? Decreased cash flow
What does the insurance billing specialist need to monitor to be able to evaluate the effectiveness of the collection process? Accounts receivable
The average amount of accounts receivable should be _____ times the charges for 1 month of services. 1.5 to 2
Accounts that are 90 days or older should not exceed _____ of the total accounts receivable. 15% to 18%
What should be done to inform a new patient of office fees and payment policies? Send a patient information brochure, send a confirmation letter, and discuss fees and policies at the time of the initial contact.
The patient is likely to be the most cooperative in furnishing details necessary for a complete registration process before any services are provided
Professional courtesy means making no charge to anyone, patient or insurance company, for medical care.
The reason for a fee reduction must be documented in the patient's medical record
When collecting fees, your goal should always be to collect the full amount
It is often the practice administrator who is responsible for the business portion of the practice. True
A large percentage of reimbursement in the physician's office is generated from third-party payers. True
Information provided on the patient registration form will prove critical to any billing and collection efforts. True
If a patient refuses to divulge any needed information on the patient registration form, the policy should be to bill the patient using the information that has been given. False
When no business or home telephone number is listed on the patient registration form, this may be an indication of a future nonpaying patient. True
A collection rate of 80% to 85% should be a goal for the practice administrator in charge of collections in the physician's office. False
Most medical practices operate with a set of fees that must be applied to all patients in the practice. True
Under federal regulations, a list of the most common services the physician offers, including procedure code numbers with a description of each service and its price, must be posted in the office waiting room. False
When a physician offers a discount, it must apply to the total bill, not just the portion that is paid by the patient. True
It is legal to offer patients a cash discount when the entire fee is paid at the time of service. True
The word _________ comes from a Latin word that means "to believe" or "to trust." credit
The unpaid balance due from patients for services that have been rendered is called accounts receivable
The relationship of the amount of money owed to a physician and the amount of money collected on the physician's accounts receivable is called the __________. collection ratio
The amount due listed on the patient's financial accounting record is also referred to as the account _______. balance
If the endorsement on the back of the payment check does not match the name on the front, there may be a case of ________. forgery
the number issued to physicians as a lifetime 10-digit number that replaces all other numbers assigned by various health plans is the NPI
The number issued to physicians by the Internal Revenue Service for income tax purposes is known as TIN
The Uniform Claim Form Task Force was replaced by National Uniform Claim Committee
To conform to CMS-1500 OCR guidelines, do not fold insurance claim forms when mailing, do not use symbols with data on insurance claims forms, do not strike over errors when making a correction n an insurance claim form
When a patient has dual coverage the insurance considered the primary insurance is generally the policy held by the patient
When completing a claim form, if any question is unanswerable, leave the space blank
When medications are considered to be experimental, the claim should be sent to the insurance carrier with a copy of the invoice from the supply house
The paper claim form was revised in 1990 and printed in red ink to allow ___________ of claims. Optical scanning
The paper claim form was revised in 2005 to allow reporting of ___ for physicians. NPI
To practice medicine within a state, a physician must obtain a physician's state license number
A dirty claim is one that had coffee spilled on it before sending to the insurance carrier. False
A paper claim is one that is submitted on paper, then optically scanned and converted to electronic form by insurance companies. True
A photocopy of the CMS 1500 claim form is acceptable if the form is processed by the insurance carrier through scanning equipment. False
A transmission report that identifies the most common reasons for claim denial is the rejection analysis report.
How often should the following procedure be done: post payments in practice management system? Daily
How often should the following procedure be done: research unpaid claims? Weekly
An internal audit that reviews who has access to PHI is a(n) ___________ safeguard or security measure. administrative
An online transaction concerning the status of an insurance claim is called a(n)_________________. electronic remittance advice
The exchange of data in a standardized format through computer systems is known as electronic data interchange. True
The most important function of a practice management system is coding of claims for submission. False
The objective of HIPAA Transaction and Code Set regulations was to standardize code sets, claim forms, and processes used in health care facilities which would reduce administrative costs.
The National Provider Identifier identifies each individual health plan and is required on all claims as of May 23, 2007. False
The newest version of electronic claims submission is known as 6020 and was required effective February 1, 2012. False
When a physician continues to treat a patient with an overdue account, the courts have viewed this as an extension of credit; therefore, patients who fall into this delinquent status should be referred elsewhere. True
"Netback" is a term used to describe a collection agency's performance
A plan in which employees can choose their own working hours from within a broad range of hours approved by management is called flex time
The first statement should be _____ of service. presented at the time
The first telephone call to the patient to try to collect on an account should be made after there is no response from the third statement
Which group of accounts would a collector target when he or she begins making telephone calls? 60 to 90 day accounts
Which type of bankruptcy is considered "wage earner's bankruptcy"? chapter 13
A medical practice has a policy of billing only for charges in excess of $50. When the medical assistant requests a $45 payment for the office visit, the patient states, "Just bill me." How should the medical assistant respond? State the office policy and ask for the full fee
All collection calls should be placed after _____ AM and before _____ PM. after 8am and before 9pm
The patient registration form should be updated at least every 6 months or each time the patient is seen
The procedure of systematically arranging the accounts receivable by age from the date of service is called age analysis
A follow-up effort made to an insurance company to locate the status of an insurance claim is called a(n) inquiry and tracer
Pending or resubmitted insurance claims may be tracked through a _____ file. Tickler
There are several ways to file pending insurance claims. What is the best way to file so that timely follow-up can be made? FILE BY PATIENT'S LAST NAME
What should be done if an insurance claim denial is received because a billed service was not a program benefit? Bill the patient with a note stating why they are being billed.
What should be done if an insurance company denies a service stating it was not medically necessary and the physician believes it was? An appeal. Write letter attach claim, attach supporting information and a letter of explanation from the physician.
What should you do if an insurance carrier requests information about another insurance carrier? provide the information
When downcoding occurs, payment will be less
A delinquent insurance claim may be easily located by reviewing the insurance claim register
A request for a hearing before an administrative law judge (in a Medicare case) may be made if the amount still in question is ____ or more. $130
The status of electronic insurance claims may be accessed quickly electronically or telephonically by digital response systems. True
There is standardization of format for the explanation of benefit document for all private insurance carriers. False
Time limits stated in individual health insurance policies about an insurance company's obligation to pay benefits are the same for all insurance companies. False
Created by: csalamon722