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Week 2
Chapters 7,8,9,& 10
| Question | Answer |
|---|---|
| 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
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