front 1 Providers have been urged to send claims electronically since: | back 1 2005 |
front 2 What is the standard claim form used for billing in medical offices? | back 2 CMS-1500 |
front 3 Prior to sending any claims to a third party for reimbursement, you should be certain that you have a copy of: | back 3 the patient's insurance card. |
front 4 Which of the following must be in place in order to file a claim electronically? | back 4 Electronic Data Interchange (EDI) |
front 5 When applying an insurance payment to a patient account on a computerized system, you are not required to post the: | back 5 amount owed by the patient. |
front 6 When would a bill for secondary insurance coverage be created? | back 6 After the payment is received from the primary insurer |
front 7 A book in which a list of insurance claims is kept is known as a: | back 7 manual insurance log. |
front 8 Which of the following means that the doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services? | back 8 Medicare assignment |
front 9 If a doctor, provider, or supplier doesn’t accept assignment of Medicare insurance, they are referred to as ____ providers | back 9 nonparticipating |
front 10 In some cases, the patient might have to submit his or her own claim to Medicare, using Form _____ in order to receive reimbursement for the costs. | back 10 CMS-14905 |
front 11 What type of claim is automatically forwarded from Medicare to a secondary insurer after Medicare has paid its portion of a service in the EHR? | back 11 Crossover claim |
front 12 It is recommended that a patient's signature on file be updated: | back 12 annually. |
front 13 Whose Social Security number is used as the insurance plan ID number? | back 13 Policy holder |
front 14 The medical assistant would log into the payer's website and enter the information on the visit if the patient is a member of a health insurance plan operated by a payer that supports: | back 14 real time adjudication. |
front 15 Misusing codes on a claim, such as upcoding or unbundling codes, is an example of: | back 15 Medicare fraud and abuse. |
front 16 A provider can charge more than the Medicare-approved amount, but there is a limit called ______ , which is up to 15 percent over the amount that nonparticipating providers are paid. | back 16 the limiting charge |
front 17 An insurance adjustment is the difference in amount from what the provider charged and the: | back 17 contracted amount with a particular insurance company. |
front 18 The amount of a non-covered service, the deductible, or out-of-pocket requirements is noted on the EOB as: | back 18 not allowed amount. |
front 19 national provider identifier | back 19 the name of the standard unique health identifier for health care providers |
front 20 secondary insurance | back 20 exists when a patient is covered under more than one insurance plan |
front 21 reimbursement | back 21 payment for provider services ( from insurance company) |
front 22 scrub | back 22 ensures that claims are correctly coded before being sent to the insurance company, which reduces denials and increases payments to the practice |
front 23 carrier | back 23 the company who provides the insurance policy |
front 24 electronic media claims | back 24 a flat file format used to transmit or transport claims |
front 25 clearinghouse | back 25 a private or public company that often serves as the middleman between physicians and billing groups, payers and other health care partners for the transmission and translation of electronic claims information into the specific format required by payers |
front 26 electronic claims tracking | back 26 computer software designed for monitoring insurance claims |
front 27 Which of the following is a disadvantage of using an outside billing service to handle patient accounts? | back 27 You do not have records in your office of current balances for your patients. |
front 28 What should you do if the practice is participating with the patient's insurance plan and the patient owes a copay at the time of service? | back 28 Collect only the copay. |
front 29 What should you do if a patient's check is returned after its initial deposit and is marked non-sufficient funds (NSF)? | back 29 Contact the bank to verify availability of funds |
front 30 With monthly billing, it is usually safe to mail a bill _____ business days in advance to ensure it is received by the first of the month. | back 30 5 to 7 |
front 31 Which of the following is the least effective means of collecting patient fees? | back 31 Through written communication |
front 32 Unless otherwise communicated, when calling a patient about a past due bill, which number should you call first? | back 32 home |
front 33 When an account is overpaid, and a refund is required to be made back to the patient or to a health insurance plan by the medical facility, a(n) ____ balance exists. | back 33 credit |
front 34 Payment plans are typically set up to have an account paid in full within ___ months. | back 34 12 |
front 35 Collection agencies typically come into play when a bill is delinquent for more than ____ months. | back 35 6 |
front 36 The Federal Trade Commission (FTC) enforces the _____ which prohibits debt collectors from using abusive, unfair, or deceptive practices to collect from a patient or customer. | back 36 fair debt collection practices act |
front 37 The two common methods of billing are monthly billing and ___ billing | back 37 cycle |
front 38 If a patient comes in for a physical examination because they are applying for life insurance coverage, who is the bill sent to? | back 38 Life insurance company |
front 39 A patient ledger within a practice management system may be called a(n): | back 39 account history. |
front 40 Which of the following is a way to identify accounts according to the length of time they have been delinquent? | back 40 aging of accounts |
front 41 When it is necessary to collect a bill owed by a deceased patient, who is the statement sent to? | back 41 The estate of the deceased in care of any known next of kin at the patient's last known address |
front 42 Accounts are considered current if within ___ of the billing date. | back 42 30 days |
front 43 viability | back 43 capable of normal growth and development |
front 44 third-party | back 44 someone other than the two principals in a transaction; when referring to checks made out to the patient by another unknown person |
front 45 skip | back 45 a person who has disappeared or moved to avoid payment of bills |
front 46 termination | back 46 ending |
front 47 outsourcing | back 47 an arrangement by which a task operation or job that could be performed by employees within a company is instead contracted to another company |
front 48 expended | back 48 spent or used as with money or energy |
front 49 idle | back 49 uninvolved; doing nothing |
front 50 nonsufficient funds | back 50 meaning the patient does not have enough money in the back account to cover the amount of the check |
front 51 date of service | back 51 the calendar date a service begins or is provided |
front 52 all time of service | back 52 when service is rendered |
front 53 antagonize | back 53 to annoy; to arouse opposition |
front 54 bankruptcy | back 54 being legally declared unable to pay debts |
front 55 alpha search | back 55 look by alphabetical order |
front 56 aging of accounts | back 56 dividing accounts into categories according to the amount of time since the first billing date |
front 57 accounts receivable | back 57 a reporting system to see who has not paid on his or her account |
front 58 account history | back 58 automatically shows the balance of the account and the number of days the account has been due |