Deck 8: Billing, Reimbursement, and Collections

Question 1

Another name for a patient encounter form is:

A) Charge slip
B) Pink slip
C) Suprabill
D) Intake form

Answer 1

Charge slip

Question 2

Forms used by the medical practice should be updated __________ and the codes verified with the current year's diagnostic and procedural codes.

A) Every three months
B) Monthly
C) Semi-Annually
D) Annually

Answer 2

Annually

Question 3

Which item does not go on the patient encounter form?

A) Patient address
B) Date of service
C) Insurance
D) Previous services

Answer 3

Previous services

Question 4

Dr. Adams has rendered a non-covered procedure to Mrs. Johnson, who is covered by Medicare. She was not advised before the procedure that it is not covered, and she did not sign the ABN. The medical office should:

A) Charge Mrs. Johnson for the procedure.
B) Obtain Mrs. Johnson's signature on an ABN.
C) Adjust the procedure charge off Mrs. Johnson's account.
D) Charge Mrs. Johnson the Medicare allowable amount for the service.

Question 5

An appointment was scheduled for a new patient, who asked how much the fee would be for the visit. What should the administrative medical assistant do?

A) Quote the highest new patient exam fee to the patient.
B) Transfer the call to the office manager.
C) Quote the mid-level new patient exam fee to the patient.
D) Provide an estimate of the exam but explain that the estimate is prior to other services, such as blood work.

Question 6

Paper insurance claim forms will produce which of the following?

A) ERA
B) EHR
C) PAR
D) EOB

Question 7

Which of the following is not necessary information on an insurance claim form?

A) Patient's gender
B) Patient's sexual orientation
C) Lab report
D) Patient's ledger

Question 8

To complete the insurance form, the medical biller/coder needs the dates when James Roberts was unable to work. To find this information, the coder would refer to the:

A) Patient's chart
B) Patient registration form
C) Lab report
D) Patient's ledger

Question 9

Before mailing patient statements, which of the following reports should be reviewed for delinquent accounts?

A) ERA
B) Aging report
C) Daily report
D) EOB

Question 10

At the end of her visit, Sarah was asked to pay $15, which is her cost for today's visit through her managed care health plan. The $15 represents Sarah's:

A) Prior account balance
B) Copayment
C) Payment toward a scheduled procedure
D) Monthly payment amount

Question 11

Listed on an account are the father, the mother, and two minor children. One insurance policy, held by the mother, covers all four family members. Who is the guarantor on the account?

A) Mother
B) Father
C) Insurance carrier
D) Mother and father

Question 12

What type of agreement becomes a permanent part of the medical record?

A) Oral agreement
B) Treatment agreement
C) Hardship agreement
D) Billing agreement

Question 13

Adult children covered under a patient's policy may continue being covered under the parent's medical insurance policy up to the age of

A) 18.
B) 21.
C) 26.
D) 30.

Question 14

Attempted collection of a debt by telephone cannot be made after:

A) 9 p.m.
B) 8 p.m.
C) 6 p.m.
D) 5 p.m.

Question 15

Attempted collection of a debt by telephone cannot be made before:

A) 9 p.m.
B) 8 p.m.
C) 7 p.m.
D) 6 p.m.

Question 16

You should not call a patient for the purpose of debt collection on a:

A) Friday
B) Monday
C) Saturday
D) Sunday

Question 17

The administrative medical assistant must call patients whose accounts are 30 to 60 days past due. All of the following are recommended phone strategies except

A) Call during evening hours prior to 9 p.m.
B) Ask why the bill has not been paid.
C) Discuss results of lab tests and/or procedures.
D) Use effective listening techniques.

Question 18

Statutes of limitations for collecting debt:

A) Are mandated by the federal government.
B) May exceed 15 years.
C) Are set state to state and may vary.
D) Are not relevant to the office collection policy.

Question 19

When a physician finds it impossible to extract payment from a patient, the account is then referred to as a __________ account.

A) closed
B) terminated
C) retired
D) termed

Question 20

A __________ is attached to the patient's file when the patient registers for a visit.

A) patient encounter form
B) patient information form
C) patient statement
D) laboratory slip

Question 21

What is the name for a list of usual procedures the office performs and the corresponding charges?

A) encounter form
B) collection list
C) fee schedule
D) routing slip

Question 22

Charges incurred by a patient for office visits, x-rays, laboratory tests, and all adjustments and payments made by the patient or patient's insurance company are recorded in/on the:

A) Encounter form
B) Patient ledger
C) Fee schedule
D) Routing slip

Question 23

The patient's copy of the information, such as charges/adjustments/payments, stored in the patient ledger is referred to as the:

A) Patient statement
B) Encounter form
C) Fee schedule
D) Routing slip

Question 24

Which of these shows the professional services rendered to the patient, the charge for each service, payments made, and the balance owed?

A) Encounter form
B) Fee schedule
C) Routing slip
D) Patient statement

Question 25

A computerized billing program is used to generate __________.

A) Fee schedules
B) Routing slips
C) Patient statements
D) Superbills

Question 26

A daily report, called a __________, lists all charges, payments, and adjustments entered during that day.

A) Encounter form
B) Collection list
C) Day sheet
D) Superbill

Question 27

A listing of medical procedures/services and usual charges is called a __________.

A) Fee Schedule
B) Encounter Form
C) Patient Statement
D) Collection List

Question 28

Which of these is known as the universal insurance claim form?

A) HIPAA-1500
B) CMS-1500
C) CMS-5010
D) HIPAA-5010

Question 29

Which of these forms is filled out and updated by the patient?

A) Patient encounter form
B) Patient information form
C) Routing slip
D) CMS-1500

Question 30

Which of these are prepared on a computer and transmitted electronically to an insurance carrier for processing to receive reimbursement?

A) Patient statements
B) Superbills
C) Electronic claims
D) Encounter forms

Question 31

A(n) _______________ is sent through the mail in response to a claim that was filed and processed.

A) EOB
B) COB
C) FTA
D) ERA

Question 32

A(n) __________ is sent electronically in response to a claim that was filed.

A) EOB
B) COB
C) FTA
D) ERA

Question 33

If the physician thinks that the reimbursement decision is incorrect, what may the medical office initiate?

A) Grievance
B) Appeal
C) Petition
D) Request

Question 34

A claim form without errors is known as what type of claim?

A) Clearinghouse
B) HIPAA
C) CMS
D) Clean

Question 35

A(n) _______________ is a service bureau that collects electronic claims from many different medical practices and forwards the claims to the appropriate insurance carriers.

A) Clearinghouse
B) Collection agency
C) Reimbursement agency
D) Insurance company

Question 36

A software program known as a _______________ may be used to check for errors on insurance claim forms before they are submitted.

A) Brushing program
B) Sweeper program
C) Scrubber program
D) Reimbursement program

Question 37

An insurance claim prepared on and transmitted by computer is called a(n)

A) CMS-1500.
B) Electronic claim.
C) Paper claim.
D) HIPAA-5010.

Question 38

What is a CMS-1500 form?

A) A universal paper claim form
B) A type of patient encounter form
C) An insurance application
D) A form used to submit an appeal

Question 39

A clearinghouse is a service that collects, corrects, and transmits ______.

A) Medical research data
B) Electronic funds transfers
C) Insurance claims
D) Patient demographic information

Question 40

A(n) _____ is a payment determination report sent by an insurance carrier.

A) EFT
B) ERA
C) CMS-1500
D) HIPAA-4010

Question 41

To whom should payments be given for processing?

A) The physician
B) The office manager
C) The administrative medical assistant
D) The insurance company representative

Question 42

When patients pay at the time of the visit by cash, check, debit card, or credit, this type of payment is known as

A) Collection at the time of service.
B) Electronic funds transfer.
C) Collection payment.
D) Third-party liability.

Question 43

What is it called when bills are sent once a month and are timed to reach the patient no later than the last day of the month?

A) Monthly billing cycle
B) Guarantor billing
C) Third-party liability billing
D) Collection billing cycle

Question 44

Which of these billing systems is designed to avoid once-a-month peak workloads and to stabilize the cash flow?

A) Third-Party billing
B) Monthly billing
C) Guarantor billing
D) Cycle billing

Question 45

Which of these takes place when the cost of a procedure is changed when the need arises?

A) Cycle billing
B) Fee adjustment
C) Collection adjustment
D) Third-party modification

Question 46

A financial adjustment for PAR providers of the difference between submitted and allowable charges is known as a

A) Fee adjustment.
B) Billing correction.
C) Write-off.
D) Collection modification.

Question 47

When a person other than the patient assumes liability, or responsibility, for the charges, it is called _______________.

A) Guarantor billing
B) Fee adjustment
C) Collection modification
D) Third-party liability

Question 48

A __________ is an individual who is a policyholder for a patient of a medical practice.

A) Policyholder
B) Dependent
C) Guarantor
D) Subscriber

Question 49

Which of these is a billing method used to provide consistent cash flow?

A) Cycle billing
B) Monthly billing
C) Guarantor billing
D) Third-party billing

Question 50

A write-off is a financial adjustment for PAR providers of the difference between

A) submitted charges and allowable charges.
B) charge amount and amount paid by the patient.
C) amount paid by the patient and amount paid by a third party.
D) estimated charges and actual charges.

Question 51

A _______________ is a service used to pursue payment for services.

A) Third-party liability agency
B) HIPAA agency
C) Terminated agency
D) Collection agency

Question 52

The percentage that shows the effectiveness of collection methods is called the

A) Dispersing ratio.
B) Accumulated ratio.
C) Collection ratio.
D) Accrual ratio.

Question 53

A terminated account may result when the physician finds it impossible to

A) diagnose the patient's condition.
B) extract payment from a patient.
C) contact the patient's insurance provider.
D) estimate the cost of a patient's procedure.

Question 54

A physician's NPI is part of the physician identifying information. What does NPI stand for?

A) National Performing Index
B) New Provider Information
C) New Performing Identifier
D) National Provider Identifier

Question 55

What should be written in large red letters across encounter forms that are not to be used?

A) DO NOT USE
B) VOID
C) INVALID
D) CANCELED

Question 56

At the end of the visit, the form is taken to the ____________ area for the administrative medical assistant to record, or post, the necessary transactions in the office's billing system.

A) Checkout
B) Clinical
C) Medical assistant
D) Confirmation

Question 57

Careful attention must be used to prevent the unauthorized disclosure of ________ when sending a statement.

A) PHI
B) HPI
C) HIP
D) PIH

Question 58

The insurance claim form contains ________________ and is transmitted to the patient's insurance carrier for partial or full reimbursement of the services rendered.

A) Clinical information only
B) Financial information only
C) Demographic and clinical information
D) Clinical and financial information

Question 59

Under HIPAA, the payment portion of TPO gives providers the authority to release claim-pertinent PHI to obtain what?

A) Third-party payment
B) Treatment from another provider
C) Access to a clearinghouse
D) Payment from the patient

Question 60

With electronic claims, Medicare claims are paid much faster - within __ days versus __ days.

A) 15; 45
B) 30; 45
C) 14; 29
D) 10; 25

Question 61

A claim may be removed from the automated review cycle and submitted for a ________ review if data for any of the processing steps are missing or is unclear.

A) Physician
B) Adjudication
C) Processing
D) Manual

Question 62

When a provider receives a check with more than one patient listed on it, it is called a ______ check.

A) Volume
B) Bulk
C) Draft
D) Sum

Question 63

After an EOB or ERA is received, it should be checked against the ______________.

A) Primary claim
B) Secondary claim
C) Tertiary claim
D) Original claim

Question 64

You a PAR provider and your patient has an 80/20 plan. You bill $1,200 to the insurance company. The insurance company has sent an EOB stating that the allowed amount is $800. How much will the patient owe?

A) $400
B) $560
C) $160
D) $0

Question 65

You a PAR provider and your patient has an 80/20 plan. You bill $1,200 to the insurance company. The insurance company has sent an EOB stating that the allowed amount is $800. How much will the office adjust?

A) $400
B) $560
C) $160
D) $0

Question 66

When speaking with a patient regarding their bill, the administrative medical assistant ______ use medical words to explain the balance.

A) Should
B) Should not
C) Is required to
D) May

Question 67

When appealing an electronic claim, you should include the _________________.

A) Electronic payer ID
B) HIPAA-835
C) Electronic claim number
D) Patient statement

Question 68

What is the first step in processing a claim?

A) Checking the accuracy of essential claim information
B) Completing the CMS-1500 Form
C) Verifying insurance information
D) Knowing the appeal process

Question 69

Typically, where are the insurance telephone numbers listed on an insurance card?

A) Front of card
B) Back of card
C) Not listed on the card
D) Both on the front and back of the card

Question 70

What are the two most common claim submission errors?

A) Incorrect insurance and invalid diagnosis codes
B) Transposition of numbers and incorrect insurance
C) Invalid diagnosis codes and typographical errors
D) Typographical errors and transposition of numbers

Question 71

The CMS-1500 is divided into how many parts?

A) 5
B) 4
C) 3
D) 2

Question 72

The CMS-1500 form is printed in what color?

A) Black
B) White
C) Red
D) Blue

Question 73

If handwritten, what color ink should be used to complete the CMS-1500 form?

A) Black
B) Green
C) Red
D) Blue