Review
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| In a health care office, the form patients fill out providing name, address, employer and health insurance information is called Pt | information form
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| Patient-staff encounters in a medical facility leave lasting impressions. These “encounters” begin when | Pt.telephones for an appointment
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| An assignment of benefits is an | arrangement by patients to allow payments to be made directly to the provider
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| Most services offered by a health care facility are not tangible, meaning they cannot be seen or felt; therefore, patients look for surrogates, which include | office location, size, and layout
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| With few exceptions, the release of information contained in a patient’s health record to a third party is | prohibited by law without written consent
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| It is human nature for patients to want to like their physicians. For these reasons, physicians should | reveal only enough information for the patient to relate to them
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| Over the next 30 years, the number of Americans over age ____ will double | 65
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| What are three of the five categories of problem debtors? | chronically slow debtors, forgetful debtors, fraudulent debtors
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| A chronological record of all patient transactions, including previous balances, charges, payments, and current balances is a | daily Journal;
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| The Federal Truth in Lending Act (1968), Regulation Z allows for an installment payment plan of more than ____________ payments | 4
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| A useful method of accounting for small practices that captures information at the time the transaction takes place is called | one write or pegboard
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| If a patient has no insurance listed, the health insurance professional should | inquire as to why there is no insurance card
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| When using patient billing software, accuracy is crucial. Additionally, in case of power fluctuation or failure, it is also crucial to | create periodic backup files
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| Health care offices send out statements periodically; this process is typically called a | billing cycle
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| The defendant is the party | being sued
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| The Fair Debt Collection Practices Act addresses abusive methods by | 3rd party collections
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| Before a small claims lawsuit can proceed, the court expects the ___________ to have explored all other avenues of settlement | plaintiff
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| An organization that obtains or arranges for payment of money owed to a third party is a | collection agency
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| A chronological listing of all transactions, considered the most basic of all office records | general journal
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| The entire grouping of patient ledgers | accounts receivable
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| A chronological accounting of a particular patient’s (or family’s) activities, including all charges and payments | Pt ledger
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| A listing of all expenses paid out to vendors, such as building rent, office supplies, salaries, etc | disbursement journal
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| A chronological record of all patient transactions, including previous balances, charges, payments, and current daily balances | daily journal
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| The “core” of a practice’s financial records | general ledger
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| A separate record some offices keep for wages and salaries | payroll ledger
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| An explanation of benefits is often referred to as a remittance | advice
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| Before the health insurance professional can complete and submit a health insurance claim | a signed and dated release of info
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| An alternative to the suspension file is to record claims information on a columnar form called a | insurance claims register
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| Services that typically require preauthorization or precertification include | inpatient hospitalization
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| Adjudication is the process by which | a claim is reviewed, payment decisions made
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| A common error that can cause a claim to be rejected is | incorrect Pt ID, missing EIN, invalid CPT-ICD 9 code
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| A 9-digit number required by businesses to serve as their taxpayer identifying number is | EIN
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| Of the various types of hearings, the one that is considered to be the most productive is the | hearing on record
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| How frequently claims are submitted can vary depending on | size of practice, office staffing, and type of claim
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| A written appeal request must contain | beneficiaries name, medicare insurance claim number
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| If patients are covered by two insurance plans, the health insurance professional may have to submit a | primary claim and secondary
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| A request for a fair hearing is pursued in one of three ways. What are the 3 ways | court hearing
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| When a coordination of benefits situation exists, the health insurance professional should first | verify which payer is primary and which is secondary
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| If the health insurance professional believes a claim has been wrongly denied, he or she can | file an appeal
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| If there is a second insurance policy, block 11d on the CMS-1500 form should be | check yes
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| The process of calling for a review of a decision made by a third-party carrier is a | appeal
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| Under normal circumstances, the health insurance professional should verify the patient’s insurance information | each time the Pt comes in
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| The term that applies when a patient and spouse are covered under two separate employer group policies is | coordination of benifits
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| When a patient presents his/her insurance ID card, the health insurance professional should | copy both sides of card
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| Time limits for submitting claims vary with insurance carriers; however, most allow | 1 year
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| When it becomes necessary to include attachments with a paper claim, what information should appear on each document | practice name, provider/group number, address, phone number
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| The document that provides such information as the charges allowed by the carrier, how much of the claim was applied to patient deductible, and/or why a service was reduced or denied is the | EOB
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| If a corrected claim must be submitted for reconsideration, the health insurance professional should mark the claim | corrected billing not duplicate claim
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| In order for Medicare to review a claim, it must include | item/services appealed, date of initial determination, beneficiary name/medicare number
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| The first level of a Medicare appeal is called the | appeal request for review
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