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Mod H Unit 4
Review
| Question | Answer |
|---|---|
| In a health care office, the form patients fill out providing name, address, employer and health insurance information is called Pt | information form |
| Patient-staff encounters in a medical facility leave lasting impressions. These “encounters” begin when | Pt.telephones for an appointment |
| An assignment of benefits is an | arrangement by patients to allow payments to be made directly to the provider |
| 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 |
| 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 |
| 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 |
| Over the next 30 years, the number of Americans over age ____ will double | 65 |
| What are three of the five categories of problem debtors? | chronically slow debtors, forgetful debtors, fraudulent debtors |
| A chronological record of all patient transactions, including previous balances, charges, payments, and current balances is a | daily Journal; |
| The Federal Truth in Lending Act (1968), Regulation Z allows for an installment payment plan of more than ____________ payments | 4 |
| A useful method of accounting for small practices that captures information at the time the transaction takes place is called | one write or pegboard |
| If a patient has no insurance listed, the health insurance professional should | inquire as to why there is no insurance card |
| 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 |
| Health care offices send out statements periodically; this process is typically called a | billing cycle |
| The defendant is the party | being sued |
| The Fair Debt Collection Practices Act addresses abusive methods by | 3rd party collections |
| Before a small claims lawsuit can proceed, the court expects the ___________ to have explored all other avenues of settlement | plaintiff |
| An organization that obtains or arranges for payment of money owed to a third party is a | collection agency |
| A chronological listing of all transactions, considered the most basic of all office records | general journal |
| The entire grouping of patient ledgers | accounts receivable |
| A chronological accounting of a particular patient’s (or family’s) activities, including all charges and payments | Pt ledger |
| A listing of all expenses paid out to vendors, such as building rent, office supplies, salaries, etc | disbursement journal |
| A chronological record of all patient transactions, including previous balances, charges, payments, and current daily balances | daily journal |
| The “core” of a practice’s financial records | general ledger |
| A separate record some offices keep for wages and salaries | payroll ledger |
| An explanation of benefits is often referred to as a remittance | advice |
| Before the health insurance professional can complete and submit a health insurance claim | a signed and dated release of info |
| An alternative to the suspension file is to record claims information on a columnar form called a | insurance claims register |
| Services that typically require preauthorization or precertification include | inpatient hospitalization |
| Adjudication is the process by which | a claim is reviewed, payment decisions made |
| A common error that can cause a claim to be rejected is | incorrect Pt ID, missing EIN, invalid CPT-ICD 9 code |
| A 9-digit number required by businesses to serve as their taxpayer identifying number is | EIN |
| Of the various types of hearings, the one that is considered to be the most productive is the | hearing on record |
| How frequently claims are submitted can vary depending on | size of practice, office staffing, and type of claim |
| A written appeal request must contain | beneficiaries name, medicare insurance claim number |
| If patients are covered by two insurance plans, the health insurance professional may have to submit a | primary claim and secondary |
| A request for a fair hearing is pursued in one of three ways. What are the 3 ways | court hearing |
| When a coordination of benefits situation exists, the health insurance professional should first | verify which payer is primary and which is secondary |
| If the health insurance professional believes a claim has been wrongly denied, he or she can | file an appeal |
| If there is a second insurance policy, block 11d on the CMS-1500 form should be | check yes |
| The process of calling for a review of a decision made by a third-party carrier is a | appeal |
| Under normal circumstances, the health insurance professional should verify the patient’s insurance information | each time the Pt comes in |
| The term that applies when a patient and spouse are covered under two separate employer group policies is | coordination of benifits |
| When a patient presents his/her insurance ID card, the health insurance professional should | copy both sides of card |
| Time limits for submitting claims vary with insurance carriers; however, most allow | 1 year |
| 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 |
| 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 |
| If a corrected claim must be submitted for reconsideration, the health insurance professional should mark the claim | corrected billing not duplicate claim |
| In order for Medicare to review a claim, it must include | item/services appealed, date of initial determination, beneficiary name/medicare number |
| The first level of a Medicare appeal is called the | appeal request for review |
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