Deck 3: Patient Encounters and Billing Information

Question 1

If the practice accepts credit and debit cards it must

A) pay a fee to a credit card company.
B) accept a discount from the patient on their bill.
C) agree to accept the allowed amount as payment in full from the insurance company.
D) wait until the claim has been processed to charge the credit card.

Answer 1

pay a fee to a credit card company.

Question 2

In what format does an encounter form come?

A) PDA only
B) paper only
C) paper and/or electronic
D) electronic only

Answer 2

paper and/or electronic

Question 3

What does a provider complete during or just after a patient's visit to summarize their billing information?

A) progress report
B) information sheet
C) encounter form
D) referral

Answer 3

encounter form

Question 4

What type of number is assigned to a HIPAA 270 electronic transaction?

A) trace number
B) identification number
C) transaction number
D) payer number

Question 5

You are working in a practice and a patient arrives for an appointment on November 20, 2019; the patient last visited the practice on March 5, 2014, and is scheduled to see the same physician. Determine what you should ask the patient to do upon arrival.

A) Review and update the information that is on file about them.
B) Complete all required forms before their first encounter with the provider.
C) The patient may see the physician without reviewing their information.
D) Call insurance company to verify coverage.

Question 6

The initial step in establishing financial responsibility is to

A) complete the patient ledger.
B) assign the medical codes.
C) Verify the patient's eligibility for insurance benefits.
D) issue patient statements.

Question 7

NonPAR stands for

A) nonparticular.
B) nonparticipating.
C) noncovered.
D) participating.

Question 8

What information must be documented in the patient's financial record when communicating with payers?

A) nothing should be documented in the financial record
B) the date of communication and the outcome
C) the representative's name, date of communication, and outcome
D) the representative name and date of communication

Question 9

When a provider asks a health plan for approval of a service, the response is known as the

A) X12 270.
B) X12 271.
C) X12 837.
D) X12 278.

Question 10

A provider such as a pathologist who does not have face-to-face interaction with a patient is called a(n)

A) indirect provider.
B) incident-to provider.
C) direct provider.
D) physician assistant.

Question 11

A patient arrives for an appointment and you need to locate his insurance information. You would use which of the following documents to find it?

A) patient information form
B) medical history form
C) notice of privacy practices
D) acknowledgment of receipt of privacy practices

Question 12

In what order are benefits typically determined when the parents do not have joint custody arrangements?

A) plan of custodial parent, plan of spouse of custodial parent, plan of parent without custody
B) plan of custodial parent and then plan of spouse of custodial parent only
C) plan of parent without custody, plan of custodial parent, plan of spouse of custodial parent
D) plan of parent without custody only

Question 13

After one health plan has paid on a claim, which insurance makes the next payment, if applicable?

A) disability insurance
B) secondary insurance
C) primary insurance
D) tertiary insurance

Question 14

Pick the type of use of PHI that a practice would employ to submit claims on behalf of a patient.

A) payment
B) treatment
C) health care operations
D) patient information form

Question 15

For unassigned claims, the payment for services rendered is expected

A) after the patient receives a statement.
B) after the insurance is billed.
C) at the time of service.
D) when the claim is sent.

Question 16

Charging TOS payments depends on

A) whether the office allows TOS payments.
B) the provision of a patient's health plan and practice's financial policy.
C) the practice's financial policy.
D) the provisions of a patient's health plan.

Question 17

Patients may have fill-in-the-gap insurance called

A) secondary insurance.
B) None of these are correct.
C) primary insurance.
D) supplemental insurance.

Question 18

Identify the information that is not typically included on an encounter form.

A) the patient's prior balance, if any
B) check boxes to indicate the timing and need for a follow-up appointment to be scheduled for the patient during checkout
C) a checklist of managed care plans under contract and their utilization guidelines
D) the patient's plan benefits

Question 19

Which HIPAA transaction is used to check patients' insurance coverage?

A) Coordination of Benefits
B) Claim Status
C) Eligibility for a Health Plan
D) Health Care Payment

Question 20

If a patient has coverage under two insurance plans, one under which the patient is the policyholder and one under which the patient is a dependent, the primary plan is

A) the plan in effect for the patient the longest.
B) the patient's plan.
C) the spouse's plan.
D) either plan, depending on coverage.

Question 21

Describe what should be done when incorrect or conflicting data are discovered on encounter forms.

A) Double-check the documentation and communicate with physician.
B) Send in without correcting and then appeal when rejected.
C) Nothing needs to be done.
D) Call the health plan.

Question 22

A patient presents for an appointment and you must locate the information about their health plan. Determine where this information should be located.

A) patient's health survey and patient information form
B) patient's information form and insurance card
C) patient's signed Acknowledgment of Receipt of Notice of Privacy Practices
D) patient's insurance card only

Question 23

What type of information is included in a patient's social history?

A) exercise habits and referring physician name and number
B) alcohol use and social security number
C) insurance information and patient address
D) smoking, alcohol use, and exercise habits

Question 24

What is another name for the HIPAA Eligibility for a Health Plan transaction?

A) X12 837
B) ABN
C) X12 278
D) X12 270/271

Question 25

A patient with no previous balance presents for an encounter and wants to know what their bill will be. Calculate the patient's estimated balance if they will receive a non-covered service worth $127.

A) $127
B) $142
C) $112
D) $15

Question 26

Assignment of benefits authorizes

A) the payer to send payments directly to the patient.
B) none of these are correct.
C) the physician to give patients completed claim forms to send to payers.
D) the physician to file claims for a patient and receive direct payments from the payer.

Question 27

In recording a patient's name when sending it to a payer, what version of their name should be used?

A) the name or nickname that they go by
B) their name as it is shown on the assignment of benefits form
C) their name as it appears on the patient information form
D) their name as it is shown on the insurance card

Question 28

Identify the person/entity that must authorize providers to release a patient's PHI for TPO purposes.

A) the patient
B) the physician
C) none of these; they do not need authorization
D) the health plan

Question 29

Determine how a policyholder can authorize physicians to submit claims on their behalf and receive payments directly from payers.

A) providing a copy of their insurance card
B) signing and dating an assignment of benefits statement
C) completing the patient information form
D) providing a copy of their driver's license

Question 30

Which of the following is used to send necessary data to payers for a claim?

A) X12 270
B) X12 278
C) X12 837
D) X12 271

Question 31

Which of these documents will the patient not complete?

A) medical history
B) encounter form
C) assignment of benefits
D) patient information form

Question 32

Under what rule is a child's primary coverage under the father's plan when both parents have coverage?

A) birthday rule
B) gender rule
C) custody rule
D) parent rule

Question 33

Patients will have the same chart number when

A) they have the same name.
B) none of these; chart numbers are unique.
C) they share the same guarantor.
D) they are minors.

Question 34

The document patients sign to signify that they have read and understood how the provider will protect their PHI is the

A) Medical History Form.
B) Assignment of Benefits.
C) Acknowledgment of Receipt of Notice of Privacy Practices.
D) Patient Information Form.

Question 35

You are working at a practice and have been asked to document some payer communications. Determine where the communications should be recorded.

A) medical record
B) financial record
C) clinical record
D) encounter form

Question 36

What type of information is not found on an insurance card?

A) member name
B) member identification number
C) group identification number
D) the date the policyholder first paid a premium

Question 37

Which of the following is gathered via the patient information form?

A) the patient's progress notes
B) the patient's examination results
C) the patient's personal and insurance information
D) the patient's discharge summary

Question 38

Patients who elect to pay a higher copayment, greater coinsurance, or both, are most likely visiting a

A) nonPAR.
B) primary care doctor.
C) PAR.
D) provider in network.

Question 39

When should the insurance specialist update the encounter form?

A) every week
B) every six months
C) every month
D) when codes change

Question 40

An RTA generates

A) the actual amount the patient will owe.
B) an estimate on the amount the patient will owe.
C) RTA does not generate these services.
D) an estimate on the amount the payer will send.

Question 41

What information does RTA allow the practice to view?

A) the amount the patient will owe
B) the amount the health plan will pay
C) the amount the health plan will pay and amount patient will owe
D) RTA does not have anything to do with payment

Question 42

What is set up in the practice management program when a patient's chief complaint is different than the one for a previous encounter?

A) identification number
B) new case
C) chart number
D) none of these are correct; nothing needs to be set up

Question 43

What can be used to verify insurance company information?

A) portal
B) TPO
C) notice of privacy practice
D) patient information form

Question 44

Determine by which of the following means a practice may receive a "self-refer."

A) the patient comes for specialty care without a referral number when one is required
B) the patient cannot self refer
C) the patient requests a referral number from their physician and gives it to the practice
D) the patient is issued a referral number from their health plan

Question 45

What type of questions should physicians be asked regarding billing and coding issues?

A) none of these are correct
B) essential
C) basic
D) basic and essential

Question 46

What type of provider is required to have patients sign an acknowledgment?

A) nonparticipating provider
B) indirect provider
C) direct provider
D) pathologist

Question 47

A "self-pay" patient is one who

A) is not the policyholder.
B) owes a copayment.
C) is a dependent of a policyholder.
D) is uninsured.

Question 48

Which HIPAA transaction is used to send information from a primary payer to a secondary payer?

A) Coordination of Benefits
B) Eligibility for a Health Plan
C) Claim Status
D) Health Care Payment

Question 49

If an employed patient has coverage under two insurance plans, one from a current employer and one from a previous employer, the primary plan is

A) the plan in effect for the patient the longest.
B) either plan, depending on coverage.
C) the previous employer's plan.
D) the current employer's plan.

Question 50

A patient has just seen the physician and received two different covered services that normally require copayments. Determine how the payment should be handled.

A) If the health plan permits multiple copayments, one is collected at the time of service, and the other is collected the next time the patient visits the practice for an encounter.
B) If the health plan permits multiple copayments, both should be collected.
C) More than one copayment can never be collected; the patient need only pay one.
D) None of these are correct.

Question 51

To make sure that all patients can follow the financial policy, it should be

A) displayed on a wall in exam rooms only.
B) included in new patient information packet only.
C) displayed on the wall of the reception area or included in new patient information packet.
D) displayed on the wall of reception area only.

Question 52

If a retired patient with Medicare also has coverage under a working spouse's plan, the primary plan is

A) Medicare.
B) the plan in effect for the longest.
C) the spouse's plan.
D) the plan with the lowest premium.

Question 53

Which of the following is another common term for encounter forms?

A) superbills
B) charge slips
C) routing slips
D) all of these are correct

Question 54

If a patient authorizes a provider to accept assignment, what can the provider now do on their behalf?

A) File claims for the patient and receive payments directly from the payer.
B) Provide treatment for a self-pay patient only.
C) Receive payments directly from the payer only.
D) Receive payments directly from the payer and provide treatment for a self-pay patient.

Question 55

You are working at a practice and need to get prior approval from a payer. Which of the following HIPAA transactions would you use to do so?

A) Referral Certification and Authorization
B) Eligibility for a Health Plan
C) Coordination of Benefits
D) Health Care Payment

Question 56

If an employed patient has coverage under two insurance plans, one the employer's plan and the other a government plan, the primary plan is

A) the government plan.
B) the employer's plan.
C) the plan with the lowest premium.
D) the plan in effect for the patient the longest.

Question 57

When the practice can get answers quickly from insurance plans, it will benefit from

A) quicker payment for services.
B) more payments for services.
C) all of these are correct.
D) larger payment for services.

Question 58

A provider who directly treats a patient is called a(n)

A) physician assistant.
B) direct provider.
C) indirect provider.
D) incident-to provider.

Question 59

Examine the types of information below and determine which type is NOT important to collect from a new patient.

A) patient/guarantor and insurance data
B) availability for future appointments
C) medical history
D) preregistration and scheduling information

Question 60

Ms. Lowell arrives for an appointment on February 8, 2017. She last visited the practice on May 14, 2016, and is scheduled to see the same physician. What should you, medical office receptionist, ask Ms. Lowell to do upon arrival?

A) Just have a seat and wait for the physician.
B) Review and update the information on file, in case there are changes.
C) Complete all forms required for new patients.
D) Call her insurance company to verify coverage.

Question 61

What Medicare form is used to show charges to patients for potentially non-covered services?

A) Acknowledgment of Receipt of Notice of Privacy Practices
B) HIPAA X 12 270/271
C) Advance Beneficiary Notice
D) Assignment of Benefits

Question 62

Which of the following entities would be given a referral number by the patient?

A) the health plan
B) the referred physician
C) the referring physician
D) the medical insurance specialist

Question 63

What should be verified when someone requests PHI for TPO purposes?

A) the person's authority to access PHI and signed acknowledgment of receipt of notice of privacy practices
B) signed acknowledgment of receipt of notice of privacy practices
C) the identity of the person and signed acknowledgment of receipt of notice of privacy practices
D) the identity of the person and person's authority to access PHI

Question 64

Another term for insured or subscriber is

A) parent.
B) established patient.
C) new patient.
D) policyholder.

Question 65

What does an Acknowledgment of Receipt of Notice of Privacy Practices state?

A) that the patient understands the practice's financial policy
B) that the patient understands how the provider intends to protect their rights to privacy under HIPAA
C) that medical records cannot be released without consent for any reason
D) that the doctor will contact the patient if insurance company wants medical records

Question 66

Under a coordination of benefits provision, when should any additional coverage be reported to the primary payer?

A) reported only if you are a participating provider with both insurance companies
B) reported only if you are a participating provider with the secondary insurance
C) it is not required to be reported at all
D) reported only if the patient has signed an assignment of benefits statement

Question 67

Under what rule is a child's primary coverage determined based upon which parent's day of birth is earlier in the calendar year?

A) custody rule
B) birthday rule
C) gender rule
D) parent rule

Question 68

Identify the means by which practices can be sure that all visits have been entered in the practice management program.

A) examination
B) all of these are correct
C) prenumbering
D) superbills

Question 69

What provision explains how insurance policies will pay if more than one policy applies?

A) birthday rule
B) gender rule
C) coordination of benefits
D) custody rule

Question 70

If a provider has agreed to accept assignment, he/she will

A) write off the deductible.
B) bill the patient for any amount not paid by the payer.
C) write off the copay/coinsurance.
D) accept the payer's allowed charge as payment in full.

Question 71

What process is used to quickly generate the amount a patient owes?

A) real-time adjudication
B) estimating what a patient owes
C) making financial arrangements
D) both real-time adjudication and making financial arrangements

Question 72

What do payers issue when they approve a service?

A) prior authorization number
B) self-referral
C) trace number
D) referral waiver

Question 73

Identify the best time during which to begin collecting patient information.

A) preregistration process
B) verification process
C) billing process
D) coordination of benefits process

Question 74

What type of charges do practices routinely collect at the time of service?

A) copays, noncovered, and self-pay patients
B) copayments or coinsurance and noncovered only
C) charges for self-pay patients only
D) noncovered or overlimit fees and self-pay patients only

Question 75

Financial policies usually contain what information?

A) credit policy, insufficient funds payment policy, and insurance information
B) insurance information and insufficient funds payment policy
C) credit policy and insurance information
D) insufficient funds payment policy and TOS collection

Question 76

What does COB stand for in medical insurance terms?

A) coordination of businesses
B) collection of benefits
C) collection of businesses
D) coordination of benefits

Question 77

Eligibility for government-sponsored plans where income is the criterion may change as quickly as

A) monthly.
B) weekly.
C) yearly.
D) daily.

Question 78

Who should the front desk at a medical office ask about whether any of their pertinent personal or insurance information has changed?

A) direct provider
B) established patients
C) referring providers
D) new patients

Question 79

Where is an assignment of benefits statement filed?

A) patient medical records and patient billing records
B) patient billing records only
C) patient medical records only
D) sent to the insurance company

Question 80

What means are available for completing an encounter form?

A) tablets
B) paper forms
C) laptops
D) all of these are correct