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MEDA160 rvwr 10 11 1

MEDA160 rvwr 10 11 12

Question	Answer
Cash flow is	the amount of actual cash generated and available for use by the medical practice within a given period of time.
When insurance carriers do not pay claims in a timely manner, what effect does this 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	1.5 to 2 times the charge for 1 month of services
Accounts that are 90 days or older should not exceed	15% to 18% of the total accounts receivable
What should be done to inform a new patient of office fees and payment policies?	send brochure, send confirmation letter, discuss fees
The patient is likely to be the most cooperative in furnishing details necessary for a complete registration process	before any services are provided
The reason for a fee reduction must be documented in the patient’s	medical record
Professional courtesy means	making no charge to anyone, patient or insurance company, for medical care
When collecting fees, your goal should always be to	collect the full amount
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?	States the office policy and ask for the full fee
The most common method of payment in the medical office is	personal check
When the physician’s office receives notice that a check was not honored, the first thing to do is to	call the bank or the patient
Accounts receivable are usually aged in time periods of	30, 60, 90, and 120 days
Messages included on statements to promote payment are called	dun messages
What is the type of billing system in which practice management software is used?	Computer billing.
Employment of a billing service is called	outsourcing
The first statement should be	presented at the time of service
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.
What is a card called that permits bank customers to make cashless purchases from funds on deposit without incurring revolving finance charges for credit?	Debit card.
How many installments (excluding a down payment) must a payment plan have to require full written disclosure?	Four or more.
Patient accounts that are 90 days or older should not exceed what percent of the total office accounts receivable?	15-18%.
What is the name of the federal act that prohibits discrimination in all areas of granting credit?	Equal Credit Opportunity Act.
What is the name of the act designed to address the collection practices of third-party debt collectors and attorneys who regularly collect debts for others?	Fair Debt Collection Practices Act.
All collection calls should be placed	after 8am and before 9pm
Which group of accounts would a collector target when he or she begins making telephone calls?	60-90 days account
In making collection telephone calls to a group of accounts, how should the accounts be organized to determine where to begin?	Organize the accounts according to amounts owed and start with the largest amount.
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.
When writing a collection letter	use a friendly tone and ask why payment has not been made
If an insurance company seems to be ignoring all efforts to trace a claim, send a copy of the	history of the account.
“Netback” is a term used to describe	a collection agency's performance
The part of the legal system that allows laypeople to settle a legal matter without use of an attorney is the	Small claims,people's court, justice court
In a bankruptcy case, most medical bills are considered	unsecured debt.
Which type of bankruptcy is considered “wage earner’s bankruptcy”?	Chapter 13
America’s oldest privately owned, prepaid medical group is the	Ross-Loos medical group
What plan allows members of Kaiser Permanente Medical Care Program to seek medical help from non-Kaiser physicians?	point of service (POS)
Kaiser Permanente’s medical plan is a closed panel program, which means	it limits the patient's choice of personal physicians.
A significant contribution to HMO development was the	Health Maintenance Act of 1973
How does an HMO receive payment for the services its physicians provide?	fee for service
When an HMO is paid a fixed amount for each patient served without considering the actual number or nature of services provided to each person, this is known as	capitation
How are physicians who work for a prepaid group practice model paid?	salary paid by independent group
What is the name of an organization of physicians sponsored by a state or local medical association that is concerned with the development and delivery of medical services and the cost of health care?	Foundation for Medical Care.
In an independent practice association (IPA), physicians are	paid salaries by their own independent group // not employees and are not paid salaries.
An organization that gives members freedom of choice among physicians and hospitals and provides a higher level of benefits if the providers listed on the plan are used is called a/an	preferred provider organization (PPO)
A physician-owned business that has the flexibility to deal with all forms of contract medicine and also offers its own plans is a/an	PPG (Physician Provider Group)
A program that offers a combination of HMO-style cost management and PPO-style freedom of choice is a/an	point of service (POS) plan
Practitioners in an HMO program may come under peer review by a professional group called a	Quality Improvement Organization
When a physician sees a patient more than is medically necessary, it is called	churning
Referral of a patient recommended by one specialist to another specialist is known as	tertiary care
What is the correct procedure to collect a copayment on a managed care plan?	collect the copayment when the patient arrives for the office visit.
Medicare Part A is run by	the center for Medicare and Medicaid Services
Medicare is a	federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
The letter “D” following the identification number on the patient’s Medicare card indicates a	widow
The letters preceding the number on the patient’s Medicare identification card indicate	railroad retiree
Part A of Medicare covers	hospital insurance (hospice care)
Part B of Medicare covers	medical services insurance (like lab tests, surgeries, and doctor visits) and supplies (like wheelchairs and walkers)
The Medicare Part A benefit period ends when a patient	has not been a bed patient in any hospital or nursing facility for 60 consecutive days
The Part B Medicare annual deductible is	$135 ($166 for the 2016)
Medicare provides a one-time baseline mammographic examination for women ages 35 to 39 and preventive mammogram screenings for women 40 years or older	once a year
The frequency of Pap tests that may be billed for a Medicare patient who is low risk is	once every 24 months
Medigap insurance may cover	the deductible not covered under Medicare
When a Medicare beneficiary has employer supplemental coverage, Medicare refers to these plans as	MSP (Medicare Secondary Payer)
Some senior HMOs may provide services not covered by Medicare, such as	eyeglasses and prescription drugs
A program that contracts with CMS to review medical necessity and appropriateness of inpatient medical care is known as a	Quality Improvement Organization (QIO)
A participating physician with the Medicare plan agrees to accept	80% of the Medicare-approved charge.
In the Medicare program, there is mandatory assignment for	Clinical laboratory tests.
A Medicare prepayment screen	identifies claims to review for medical necessity and monitors the number of times given procedures can be billed during a specific time frame.
When a Medicare patient signs an advance beneficiary notice, the procedure code for the service provided must be modified using the HCPCS Level II modifier	GA
Under the prospective payment system (PPS), hospitals treating Medicare patients are reimbursed according to	preestablished rates for each type of illness treated based on diagnosis
Payments to hospitals for Medicare services are classified according to	DRG's (Diagnosis Related Group)
The 1987 Omnibus Budget Reconciliation Act (OBRA) established the	MAAC (Maximum Allowable Actual Charge)
The HCPCS national alphanumeric codes are referred to as	Level II Codes
Organizations handling claims from hospitals, nursing facilities, intermediate care facilities, long-term care facilities, and home health agencies are called	fiscal intermediaries
The time limit for submitting a Medicare claim is	the end of the calender year following the fiscal year in which services were performed
When a Medicare carrier transmits a Medigap claim electronically to the Medigap carrier, it is referred to as a/an	crossover claim
An explanation of benefits document for a patient under the Medicare program is referred to as the	Medicare remittance advice document
A claims assistance professional (CAP)	may act on the Medicare beneficiary's behalf as a client representative
When a remittance advice (RA) is received from Medicare, the insurance billing specialist should	post each patient's name and the amount of payment on the day sheet and the patient's ledger card
If a check is received from Medicare and it is obvious that it is an overpayment, the insurance billing specialist should	deposit the check and then write to Medicare to notify them of the overpayment

Created by: FB

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