Question 1

Providers have the option of arranging for __________, which means that payers deposit reimbursement for health care services to the provider's account electronically.

Accepted Answer

Electronic funds transfer (EFT) is the process by which payers deposit reimbursement for healthcare services directly into the provider's account electronically.

Question 2

The patient underwent office surgery on March 18, and the third-party payer determined the allowed charge to be $1,480. The patient paid the 20 percent coinsurance at the time of the office surgery. The physician and patient each received a check for $1,184, and the patient signed her check over to the physician. The overpayment was __________, and the physician must reimburse the third-party payer.

Accepted Answer

The answer of The patient underwent office surgery on March...

Question 3

Medicare calls its remittance advice a(n) __________.

Accepted Answer

Medicare refers to its remittance advice as a "provider remittance notice."

Question 4

Which amended the Truth in Lending Act and requires prompt written acknowledgment of consumer billing complaints and investigation of billing errors by creditors?

Accepted Answer

The Fair Credit Billing Act amended the Truth in Lending Act to address billing errors and requires creditors to promptly acknowledge and investigate consumer billing complaints.

Question 5

A remittance advice submitted to the provider electronically is called an electronic remittance advice (ERA), and __________.

Accepted Answer

An electronic remittance advice (ERA) contains the same information as a paper-based remittance advice, but it is delivered in an electronic format.

Question 6

Which claims are filed according to year and insurance company and include those for which all processing, including appeals, has been completed?

Accepted Answer

Closed claims are those for which all processing, including appeals, has been completed, and they are filed according to year and insurance company.

Question 7

Which protects information collected by consumer reporting agencies such as credit bureaus, medical information companies, and tenant screening services?

Accepted Answer

The Fair Credit Reporting Act (FCRA) is the federal law that regulates the collection, dissemination, and use of consumer information, including consumer credit information, by consumer reporting agencies.

Question 8

A pre-existing condition is any medical condition that was diagnosed and/or treated within a specified period of time __________ the enrollee's effective date of coverage.

Accepted Answer

A pre-existing condition refers to any medical condition that was diagnosed or treated before the enrollee's effective date of coverage.

Question 9

A delinquent account is also called a __________ account, which means it is one that has not been paid within a certain time frame (e.g., 120 days). Following up on such delinquent accounts is crucial to the success of the business.

Accepted Answer

A delinquent account is referred to as a "past-due" account because it has not been paid within the agreed time frame.

Question 10

An appeal is documented as a(n) __________ why a claim should be reconsidered for payment.

Accepted Answer

An appeal is typically documented as a letter signed by the provider explaining why a claim should be reconsidered for payment. This letter provides the necessary details and justification for the appeal.

Question 11

Which is considered a financial source document from which an insurance claim is generated?

Accepted Answer

An encounter form is a financial source document used to capture the services provided to a patient, which is then used to generate an insurance claim.

Question 12

The delinquent claim cycle advances through aging periods, and providers typically focus __________ recovery efforts for older delinquent claims.

Accepted Answer

Providers typically focus internal recovery efforts for older delinquent claims.

Question 13

Which requires providers to make certain written disclosures concerning all finance charges and related aspects of credit transactions (including disclosing finance charges expressed as an annual percentage rate)?

Accepted Answer

The Truth in Lending Act requires lenders to disclose finance charges and the annual percentage rate to consumers, ensuring transparency in credit transactions.

Question 14

Which claims are organized by month and insurance company after submission to the payer, but for which processing is not complete?

Accepted Answer

Open claims are those that have been submitted to the payer but are still in the process of being reviewed or processed, hence they are organized by month and insurance company until processing is complete.

Question 15

Which prohibits discrimination on the basis of race, color, religion, national origin, sex, marital status, age, receipt of public assistance, or good-faith exercise of any rights under the Consumer Credit Protection Act?

Accepted Answer

The Equal Credit Opportunity Act prohibits discrimination in credit transactions based on race, color, religion, national origin, sex, marital status, age, receipt of public assistance, or the good-faith exercise of any rights under the Consumer Credit Protection Act.

Question 16

Which claims are organized by year and are generated for providers who do not accept assignment?

Accepted Answer

Unassigned claims are those generated for providers who do not accept assignment, meaning they do not have a contract with the payer to accept the approved amount as full payment.

Question 17

Which states that third-party debt collectors are prohibited from employing deceptive or abusive conduct in the collection of consumer debts incurred for personal, family, or household purposes?

Accepted Answer

The Fair Debt Collection Practices Act (FDCPA) is the law that prohibits third-party debt collectors from using deceptive or abusive practices in the collection of consumer debts.

Question 18

Which are the amounts owed to a business for services or goods provided?

Accepted Answer

Accounts receivable are the amounts owed to a business for services or goods provided.

Question 19

Which establishes the rights, liabilities, and responsibilities of participants in electronic fund transfer systems?

Accepted Answer

The Electronic Funds Transfer Act establishes the rights, liabilities, and responsibilities of participants in electronic fund transfer systems.

Question 20

Which amended the Truth in Lending Act and requires credit and charge card issuers to provide certain disclosures in direct mail, telephone, and other applications and solicitations for open-ended credit and charge accounts and under other circumstances?

Accepted Answer

The Fair Credit and Charge Card Disclosure Act amended the Truth in Lending Act to require credit and charge card issuers to provide specific disclosures in various applications and solicitations for open-ended credit and charge accounts.

Quiz 4: Processing an Insurance Claim