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MED112 CODE/BILL
MED112 CH 03 SB PATIENT ENCOUNTERS AND BILLING INFORMATION
| Question | Answer |
|---|---|
| MED112 CH 03 SB | |
| One of the five types of information that is important when a patient is new to the practice is _____. - authorization to treat - advance directives - assignment of benefits - health care power of attorney | assignment of benefits |
| What is the name of the process performed in a medical practice to check the patient's health requirements are appropriate for the medical practice? - Preregistration process - Benefits review process - Verification of benefits process - Utilization process | Preregistration process |
| When a practice asks a new patient to complete the medical history electronically in the reception area, the patient may use a _____. - paper form - tablet - personal computer - cell phone | tablet |
| The patient information form is used to collect _____ information. - insurance - medical history - demographic - injury or accident | demographic |
| When the policyholder authorizes insurance payments to be sent directly to the physician, this is known as _____. - coordination of benefits - insurance verification - release of information - assignment of benefits | assignment of benefits |
| Select all of the following elements that are important pieces of information when a patient is new to the practice. - Patient or guarantor and insurance data - Acknowledgment of Receipt of Notice of Privacy Practices - Release of Information form - Medical history | Patient or guarantor and insurance data Acknowledgment of Receipt of Notice of Privacy Practices Medical history |
| What is the acronym under the HIPAA Privacy Rule when a provider does not need specific authorization to release patient health information (PHI)? - EPO - PPO - ETA - TPO | TPO |
| When does the collection of information begin when a patient is new to the practice? - After the patient's insurance is billed - Before the patient is seen by the physician - Before the patient arrives for the appointment - After the patient is seen by the physician | Before the patient arrives for the appointment |
| Every year an established patient should be given a current copy of the _____. - Release of Information authorization - Notice of Privacy Practices - Coordination of Benefits form - Advance Beneficiary Notice | Notice of Privacy Practices |
| When a new patient is seen at a medical practice, it is required that a patient completes _____ forms. - benefit - mental - authorization - medical history | medical history |
| The computerized database that is set up about the practice's income and expense accounting is called a(n) _____. - Accounts Payable Program - Preferred Provider Network - Practice Management Program - Assignment of Benefits | Practice Management Program |
| Select all of the following pieces of information that are listed on the patient information form. - Race and ethnicity - Home address - Marital status - Pre-existing conditions | Race and ethnicity Home address Marital status |
| What is the advantage for the physician in obtaining the assignment of benefits? - Payments are increased - Payments are faster - There is less paperwork - Prior authorization is given | Payments are faster |
| What is the first step to determine patient's financial responsibility? - Determine the primary payer if more than one insurance plan is in effect. - Determine if the medical condition was a pre-existing condition. - Verify patient's eligibility for insurance benefits. - Determine preauthorization and referral requirements. | Verify patient's eligibility for insurance benefits. |
| Which of the following are exclusions to the HIPAA Privacy Rule in releasing PHI? (More than one answer may be correct.) - Payment - Treatment - Utilization - Operations | Payment Treatment Operations |
| Select all of the following that are factors in affecting eligibility for benefits for an HMO patient. - The provider is a plan participant. - The patient has met the deductible. - The patient does not have a preexisting condition. - The patient is assigned to the PCP as of the date of service. - The patient is listed on the plan's enrollment master list. | The provider is a plan participant. The patient is assigned to the PCP as of the date of service. The patient is listed on the plan's enrollment master list. |
| Front desk staff members must ensure information for established patients is _____. - up-to-date - accurate - reviewed - released | up-to-date |
| If a patient has insurance coverage but the provider does not participate in their plan, the medical insurance specialist should verify the _____ benefit. - out-of-network - preventative - coordination - nonparticipating | out-of-network |
| What information is found in the PMP? - Malpractice coverage and premiums - Required documentation for physician continuing medical education - Physician and other health professionals medical education and experience - Physician and other health professionals who work in the practice | Physician and other health professionals who work in the practice |
| Which of the following is true about the verification of copayments and coinsurance? - Copayments and coinsurance amounts do not change. - Insurance cards do not list copayments or coinsurance. - The amount of the copayment and coinsurance should be checked at the time of service. - Insurance cards are up-to-date with copayments and coinsurance. | The amount of the copayment and coinsurance should be checked at the time of service. |
| When should patients be called to remind them of appointment times? - A two or three days before their appointment - A day or two before their appointment - Twelve hours before their appointment - An hour before their appointment | A day or two before their appointment |
| What is the next step after the medical insurance specialist verifies the patient's eligibility for insurance benefits? - Determine if the patient has a pre-existing condition - Determine preauthorization and referral requirements. - Determine the primary payer if more than one insurance plan is in effect. - Verify the patient has selected a primary care physician. | Determine preauthorization and referral requirements. |
| What must be returned when the practice sends the HIPAA standard transaction? - Notice of Privacy Practices - Electronic eligibility verification - Assignment of Benefits - Release of Information | Electronic eligibility verification |
| If the patient is part of an HMO health plan, the patient must be _____ to the PCP as of the date of service. - eligible - referred - contracted - assigned | assigned |
| What is the name of the financial agreement form given to notify patients of their obligation to pay the bill before the services are given? - Explanation of Benefits - CMS 1500 - Advanced Beneficiary Notice - Notice of Privacy Practices | Advanced Beneficiary Notice |
| Who is responsible for payment when the health plan does not allow for out-of-network benefits? - The spouse - The patient - The health plan - The parent | The patient |
| What is another term used for the prior authorization number? - Certification number - Utilization number - Referral number - Benefit number | Certification number |
| If the patient has a copayment or coinsurance required at the time of service, it must be checked and _____. - billed - collected - written off - credited | collected |
| Which document is given to the referred physician that provides a written request for medical services? - EOB - Referral - COB - Release of Information | Referral |
| If the service is not covered, the patient should be made aware of financial responsibility _____. - after the health plan has received the claim - after the service - during the visit - in advance | in advance |
| When an electronic eligibility verification is sent, the computer program assigns a unique _____ number to the inquiry. - trace - referral - benefit - eligibility | trace |
| What explains how an insurance policy will pay if more than one policy applies? - Assignment of benefits - Advanced beneficiary notice - Explanation of benefits - Coordination of benefits | Coordination of benefits |
| Under Medicare, the ABN must be given to the patient and signed _____ receiving uncovered services. - while - within two days after - immediately after - prior to | prior to |
| A person may have primary insurance coverage from an employer-sponsored insurance and a policy from _____ membership. - dependent - union - tertiary - payment | union |
| When a payer approves the service, it issues a _____ number. - prior authorization - benefit - referral - verification of benefit | prior authorization |
| The authorization number given to the referred physician is known as the _____. - referral waiver - utilization number - precertification transaction - referral number | referral number |
| Who is responsible for determining whether the planned encounter is a covered service? - The medical insurance specialist - The physician or health care provider - The receptionist - The medical assistant | The medical insurance specialist |
| What is the meaning of the acronym COB? - Coordination of benefits - Claim on benefits - Coordination of beneficiary - Contract on business | Coordination of benefits |
| Under the birthday rule, the parents whose day of birth is earlier in the calendar year is _____. - principle - tertiary - secondary - primary | primary |
| Select all of the following that could be possible reasons why a patient may have coverage under more than one group plan. - The patient may have coverage under Medicaid and a supplemental insurance policy. - The patient may have coverage from an employer but also be covered as a spouse. - The patient may have coverage from an employer but also be covered as a dependent. - The patient may have coverage under an employer sponsored insurance and a policy from union membership. | The patient may have coverage from an employer but also be covered as a spouse. The patient may have coverage from an employer but also be covered as a dependent. The patient may have coverage under an employer sponsored insurance and a policy from union membership. |
| Assuming that information regarding current payers is already in the database, which types of changes must be updated in the PMP's payer database? - New payer representative's contact information - Referral waiver number - New participation agreements - Coordination of benefit guidelines | New payer representative's contact information New participation agreements |
| Select all of the following guidelines for effective communication with payers. - Review all changing reimbursement policies only from printed bulletins or newsletters. - Invite the representative of each payer to visit the office. - Use a courteous and professional telephone manner or writing style. - Learn the name of the appropriate representative of each payer. | Invite the representative of each payer to visit the office. Use a courteous and professional telephone manner or writing style. Learn the name of the appropriate representative of each payer. |
| If both parents cover a dependent on their plans, the child's primary insurance is usually determined by the _____ rule. - COB - dependent - parent - birthday | birthday |
| Who should sign and date the completed encounter form? - The medical insurance specialist - The physician - The administrative medical assistant - The patient | The physician |
| What information is contained in database of payers in the PMP? - Plan type - Telephone number - Payer's name - Fee schedule | Plan type Telephone number Payer's name |
| According to the practice's encounter form policy, how are the encounter forms distributed? - A copy is filed in the financial record. - A copy is filed in the medical record. - A copy is given to the patient. - A copy is submitted to the health plan. | A copy is filed in the financial record. A copy is filed in the medical record. A copy is given to the patient. |
| Where in the patient record should the medical insurance specialist document the communication with a payer representative? - Abstract record - Personal record - Financial record - Clinical record | Financial record |
| The form that lists the patient's diagnoses, procedures, and charges for a visit is called the _____ form. - assignment of benefits - EOB - ABN - encounter | encounter |
| What information listed on encounter forms should be updated by the medical specialist? - Diagnosis codes - ABN waivers - Procedure codes - Payer's coverage | Diagnosis codes Procedure codes Payer's coverage |
| Up-front collection is money collected _____. - after the patient leaves the office - after the health plan is billed - before the patient comes in for a service - before the patient leaves the office | before the patient leaves the office |
| Which related facts are entered into the PMP regarding insurance information? - Effective dates - Secondary coverage - Policy numbers - Release of information | Effective dates Secondary coverage Policy numbers |
| What items can be listed on a customized encounter form? - The patient's name - Patient's full medical history - The patient's previous balance - Payments made by the patient | The patient's name The patient's previous balance Payments made by the patient |
| The practice's rules governing payment for patients is called the _____. - revenue cycle - explanation of payment - assignment of benefits - financial policy | financial policy |
| Who ensures databases related to diagnosis and procedure codes listed on encounter forms are updated? - The medical insurance specialist - The office manager - The health plan specialist - The physician | The medical insurance specialist |
| Which of the following charges are routinely collected at the time of service? - Deductibles for patients with PPO plans - Coinsurance - Previous balances - Copayments | Coinsurance Previous balances Copayments |
| Which of the following should be considered when calculating what the patient will owe? - The payer's allowed charges - Whether the patient has accepted assignment - The patient's coinsurance - The patient's deductible amount | The payer's allowed charges The patient's coinsurance The patient's deductible amount |
| Why should the provider wait until the claim is adjudicated before billing the patient? - The provider is required to accept assignment. - The patient's actual amount due is not known. - The adjudication may results in a change of the amount due. - Differences in participation contracts may reduce the physician's fee. | The patient's actual amount due is not known. The adjudication may results in a change of the amount due. Differences in participation contracts may reduce the physician's fee. |
| Where should the practice's financial policy be displayed or included? - It should be displayed in the exam rooms. - It should be included with the health plan contract. - It should be included in the new patient information packet. - It should be displayed on the wall of the reception area. | It should be included in the new patient information packet. It should be displayed on the wall of the reception area. |
| The process used to generate the amount owed by a patient is called _____. - real-time adjudication - verification of payment - assignment of benefits - advanced adjudication | real-time adjudication |
| What information should be documented in the patient's financial record when communicating with the payer representative? - The date of communication - The authorization to release information - The description of the outcome - The representative's name | The date of communication The description of the outcome The representative's name |
| The policy of collecting and retaining patient's credit card information is known as _____. - automatic assignment - credit card on file - electronic adjudication - automated billing | credit card on file |
| What does the acronym RTA represent? - Rights to appeal - Real-time application - Real-time adjudication - Real-time alteration | Real-time adjudication |
| What information does a patient information form gather? - the patient's insurance plan deductible and/or copayment requirements - the patient's history of present illness, past medical history, and examination results - the patient's personal information, employment data, and insurance information - the patient's chief complaint | the patient's personal information, employment data, and insurance information |
| If a husband has an insurance policy but is also eligible for benefits as a dependent under his wife's insurance policy, the wife's policy is considered ____________ for him. - primary - secondary - coordinated - participating | secondary |
| A certification number for a procedure is the result of which transaction and process? - health care payment and remittance advice - coordination of benefits - referral and authorization - claim status | referral and authorization |
| A practice's rules for payment for medical services are found in its - financial policy. - coordination of benefits. - compliance plan. - documentation. | financial policy. |
| The encounter form is a source of ____________ information for the medical insurance specialist. - credit card - treatment plan - third-party payment - billing | billing |
| Under Medicare, what must a provider receive before it is permitted to collect a deductible or any other payment? - the patient's coinsurance - data on how the claim is going to be paid - the patient's copayment - authority to accept assignment | data on how the claim is going to be paid |
| Which charges are usually collected at the time of service? - copayments, noncovered or overlimit fees, charges of nonparticipating providers, and charges for self-pay patients - coinsurance - copayments, lab fees, and therapy charges - deductibles and lab fees | copayments, noncovered or overlimit fees, charges of nonparticipating providers, and charges for self-pay patients* |
| The tertiary insurance pays - after the first and second payers. - after the first payer. - before all other payers. - after receipt of the claim. | after the first and second payers. |
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