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Stack #184737

Medical Reimbursements and HIPAA

QuestionAnswer
T/FThe exchange of data in a standardized format through computer connections is known as electronic data interchange. True
T/FAn installed firewall and antivirus software helps maintain computer security. True
T/FThere is standardization of format for the EOB document for all private insurance carriers. False
T/FIn any type of overpayment situation, always cash the third-party payer's check and write a refund check payable to the originator of the overpayment. True
T/FAn official appeal may be made either by telephone or in writing.An official appeal may be made either by telephone orin writing. False
T/FThe highest level of a Medicare redetermination is with an administrative law judge. False
T/FInformation provided on the patient registration form will prove critical to any billing and collection efforts. True
T/FA collection of 80% to 85% should be a goal for the practise administrator in charge of collections in the physician's office. False
T/FWhen a physician offers a discount, it must apply to the total bill, not just the portion that is paid by the patient. True
T/FIn most situations, both private insurers and the federal government ban waiving the copayment portion of the patient's fee. True
T/FA medical practise cannot refuse to let an established patient see the doctor because of a debt. True
T/FOne person or one department should handle all billing questions. True
T/FA patient has a $600 balance and agrees to a payment plan 0f $100 in six installments. If he/she skips the third installment and sends in $25 the following month, the physician can send the account to collections. True
T/FAccording to the FDCPA, debtors can never be contacted at work. False
T/FInsurance billing specialists who handle checks or cash should be bonded and insured. True
T/FUCR system stands for usual, customary, reasonable where reimbursement is based on the lower of the UCR fees. True
T/FThe adjustment factor for regional overhead and malpractise costs is referred to as the conversion factor. False
Insurance claims transmitted electronically are usually paid in? 2 weeks or less
The employer's identification number is assigned by? The IRS
Back-up copies of office records should be stored? Away from the office.
If a payment problem delevops with an insurance company and the company ignores claims and exceeds time limits to pay a claim, it is prudent to contact the? State Insurance Commissioner.
When receiving payment from a private insurance carrier, check the amount of payment on the EOB with the? Patient's financial accounting record or copy of the CMS-1500 Form.
A follow-up effort made to an insurance company to locate the status of an insurance claim is called a/an? Inquiry or Tracer.
When downcoding occurs, payment will? Be less.
The first level of appeal in the Medicare program is? Redetermination.
Cash flow is? The ongoing availability of cash in the medical practise.
What does the insurance billing specialist need to monitor to be able to evaluate the effectiveness of the collection process? Accounts Receivable
What should be done to inform a new patient of office fees and payment policies> Send a patient information brochure; send a confirmation letter; discuss fees and policies at the time of the initial contact.
The reason for a fee reduction must be documented in the patient's? Medical Record
The most common method of payment in the medical office is? Personal check.
Messages included on statements to promote payment are called? Dun Messages.
The first telephone call to the patiens to try to collect on an account should be made? After there is no response from the third statement.
What is the name of the act designed to address the collection practises of third-party debt collectors and attorneys who regularly collect debt for others? Fair Debt Collection Practises Act.
When writting a collection letter? Use friendly tone and ask why payment has not been made.
The part of the legal system that allows laypeople to settle a legal matter without the use of an attorney is the ? Small Claims Court.
Resource Based Relative Value Scale (RBRVS) was developed to? Distirbute medical dollars more equitably and control escalating costs.
(WB) A combination of letters, numbers, or symbols that each individual is assigned to access the computer system is called a/an? Password
An automatic log-off that prevents unauthorized users from accessing a computer is a/an BLANK safeguard? Technical
Monitoring the activities of insurance companies and making sure that the interests of the policyholders are protected is the job of the insurance BLANK? Commision.
An insurance claim is pending because of the need for additional information is also referred to as being in BLANK? Suspense.
Generally, if a bill has not been paid, the physician rebills the patient every BLANK? 30 days.
The unpaid balnace due from patients for services that have rendered is called BLANK Accounts Receivable.
The patient information registration for should be updated at least every BLANK months? Six
A formal regulation or law setting a time limit on legal action is known as BLANK? Statue of limitations.
A patient who owes a balance on his/her account and moves and leaves no forwarding address is called a BLANK? Skip.
A/an BLANK is a claim on the property of another as security for a debt. Lein.
The three kinds of information system safeguards are? 1) Administrative; 2) Technical; 3) Physical.
Created by: douelt
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