Chapters 7,8,9,& 10
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
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| Cash flow is the | ongoing availability of cash in the medical practice
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| When insurance carriers do not pay claims in a timely manner, what effect does it have on the medical practice? | Decreased cash flow
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| What does the insurance billing specialist need to monitor to be able to evaluate the effectiveness of the collection process? | Accounts receivable
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| The average amount of accounts receivable should be _____ times the charges for 1 month of services. | 1.5 to 2
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| Accounts that are 90 days or older should not exceed _____ of the total accounts receivable. | 15% to 18%
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| 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.
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| The patient is likely to be the most cooperative in furnishing details necessary for a complete registration process | before any services are provided
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| Professional courtesy means | making no charge to anyone, patient or insurance company, for medical care.
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| The reason for a fee reduction must be documented in the patient's | medical record
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| When collecting fees, your goal should always be to | collect the full amount
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| It is often the practice administrator who is responsible for the business portion of the practice. | True
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| A large percentage of reimbursement in the physician's office is generated from third-party payers. | True
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| Information provided on the patient registration form will prove critical to any billing and collection efforts. | True
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| 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
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| 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
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| 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
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| Most medical practices operate with a set of fees that must be applied to all patients in the practice. | True
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| 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
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| When a physician offers a discount, it must apply to the total bill, not just the portion that is paid by the patient. | True
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| It is legal to offer patients a cash discount when the entire fee is paid at the time of service. | True
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| The word _________ comes from a Latin word that means "to believe" or "to trust." | credit
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| The unpaid balance due from patients for services that have been rendered is called | accounts receivable
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| 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
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| The amount due listed on the patient's financial accounting record is also referred to as the account _______. | balance
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| 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
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| the number issued to physicians as a lifetime 10-digit number that replaces all other numbers assigned by various health plans is the | NPI
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| The number issued to physicians by the Internal Revenue Service for income tax purposes is known as | TIN
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| The Uniform Claim Form Task Force was replaced by | National Uniform Claim Committee
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| 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
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| When a patient has dual coverage the insurance considered the primary insurance is | generally the policy held by the patient
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| When completing a claim form, if any question is unanswerable, | leave the space blank
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| 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
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| The paper claim form was revised in 1990 and printed in red ink to allow ___________ of claims. | Optical scanning
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| The paper claim form was revised in 2005 to allow reporting of ___ for physicians. | NPI
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| To practice medicine within a state, a physician must obtain a physician's state | license number
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| A dirty claim is one that had coffee spilled on it before sending to the insurance carrier. | False
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| A paper claim is one that is submitted on paper, then optically scanned and converted to electronic form by insurance companies. | True
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| A photocopy of the CMS 1500 claim form is acceptable if the form is processed by the insurance carrier through scanning equipment. | False
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| A transmission report that identifies the most common reasons for claim denial is the | rejection analysis report.
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| How often should the following procedure be done: post payments in practice management system? | Daily
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| How often should the following procedure be done: research unpaid claims? | Weekly
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| An internal audit that reviews who has access to PHI is a(n) ___________ safeguard or security measure. | administrative
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| An online transaction concerning the status of an insurance claim is called a(n)_________________. | electronic remittance advice
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| The exchange of data in a standardized format through computer systems is known as electronic data interchange. | True
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| The most important function of a practice management system is coding of claims for submission. | False
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| 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. |
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| The National Provider Identifier identifies each individual health plan and is required on all claims as of May 23, 2007. | False
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| The newest version of electronic claims submission is known as 6020 and was required effective February 1, 2012. | False
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| 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
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| "Netback" is a term used to describe | a collection agency's performance
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| 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
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| The first statement should be _____ of service. | presented at the time
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| 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
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| Which group of accounts would a collector target when he or she begins making telephone calls? | 60 to 90 day accounts
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| Which type of bankruptcy is considered "wage earner's bankruptcy"? | chapter 13
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| 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
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| All collection calls should be placed after _____ AM and before _____ PM. | after 8am and before 9pm
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| The patient registration form should be updated at least every | 6 months or each time the patient is seen
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| The procedure of systematically arranging the accounts receivable by age from the date of service is called | age analysis
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| A follow-up effort made to an insurance company to locate the status of an insurance claim is called a(n) | inquiry and tracer
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| Pending or resubmitted insurance claims may be tracked through a _____ file. | Tickler
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| 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
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| 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.
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| 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.
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| What should you do if an insurance carrier requests information about another insurance carrier? | provide the information
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| When downcoding occurs, payment will | be less
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| A delinquent insurance claim may be easily located by reviewing the | insurance claim register
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| 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
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| The status of electronic insurance claims may be accessed quickly electronically or telephonically by digital response systems. | True
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| There is standardization of format for the explanation of benefit document for all private insurance carriers. | False
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| 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
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