Providers have been urged to send claims electronically since:

2005

What is the standard claim form used for billing in medical offices?

CMS-1500

Prior to sending any claims to a third party for reimbursement, you should be certain that you have a copy of:

the patient's insurance card.

Which of the following must be in place in order to file a claim electronically?

Electronic Data Interchange (EDI)

When applying an insurance payment to a patient account on a computerized system, you are not required to post the:

amount owed by the patient.

When would a bill for secondary insurance coverage be created?

After the payment is received from the primary insurer

A book in which a list of insurance claims is kept is known as a:

manual insurance log.

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?

Medicare assignment

If a doctor, provider, or supplier doesn’t accept assignment of Medicare insurance, they are referred to as ____ providers

nonparticipating

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.

CMS-14905

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?

Crossover claim

It is recommended that a patient's signature on file be updated:

annually.

Whose Social Security number is used as the insurance plan ID number?

Policy holder

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:

real time adjudication.

Misusing codes on a claim, such as upcoding or unbundling codes, is an example of:

Medicare fraud and abuse.

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.

the limiting charge

An insurance adjustment is the difference in amount from what the provider charged and the:

contracted amount with a particular insurance company.

The amount of a non-covered service, the deductible, or out-of-pocket requirements is noted on the EOB as:

not allowed amount.

national provider identifier

the name of the standard unique health identifier for health care providers

secondary insurance

exists when a patient is covered under more than one insurance plan

reimbursement

payment for provider services ( from insurance company)

scrub

ensures that claims are correctly coded before being sent to the insurance company, which reduces denials and increases payments to the practice

carrier

the company who provides the insurance policy

electronic media claims

a flat file format used to transmit or transport claims

clearinghouse

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

electronic claims tracking

computer software designed for monitoring insurance claims

Which of the following is a disadvantage of using an outside billing service to handle patient accounts?

You do not have records in your office of current balances for your patients.

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?

Collect only the copay.

What should you do if a patient's check is returned after its initial deposit and is marked non-sufficient funds (NSF)?

Contact the bank to verify availability of funds

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.

5 to 7

Which of the following is the least effective means of collecting patient fees?

Through written communication

Unless otherwise communicated, when calling a patient about a past due bill, which number should you call first?

home

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.

credit

Payment plans are typically set up to have an account paid in full within ___ months.

12

Collection agencies typically come into play when a bill is delinquent for more than ____ months.

6

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.

fair debt collection practices act

The two common methods of billing are monthly billing and ___ billing

cycle

If a patient comes in for a physical examination because they are applying for life insurance coverage, who is the bill sent to?

Life insurance company

A patient ledger within a practice management system may be called a(n):

account history.

Which of the following is a way to identify accounts according to the length of time they have been delinquent?

aging of accounts

When it is necessary to collect a bill owed by a deceased patient, who is the statement sent to?

The estate of the deceased in care of any known next of kin at the patient's last known address

Accounts are considered current if within ___ of the billing date.

30 days

viability

capable of normal growth and development

third-party

someone other than the two principals in a transaction; when referring to checks made out to the patient by another unknown person

skip

a person who has disappeared or moved to avoid payment of bills

termination

ending

outsourcing

an arrangement by which a task operation or job that could be performed by employees within a company is instead contracted to another company

expended

spent or used as with money or energy

idle

uninvolved; doing nothing

nonsufficient funds

meaning the patient does not have enough money in the back account to cover the amount of the check

date of service

the calendar date a service begins or is provided

all time of service

when service is rendered

antagonize

to annoy; to arouse opposition

bankruptcy

being legally declared unable to pay debts

alpha search

look by alphabetical order

aging of accounts

dividing accounts into categories according to the amount of time since the first billing date

accounts receivable

a reporting system to see who has not paid on his or her account

account history

automatically shows the balance of the account and the number of days the account has been due