Question 1

Dr. Lewis's office collects patients' co-pays at the time of arrival; Dr. Mbadu's office collects the co-pay as the patient is leaving the visit. Is one method more advisable than the other? Explain your answer.

Accepted Answer

The answer of Dr. Lewis's office collects patients' co-pays at...

Question 2

An electronic claims process is more efficient than a manual process. Why?

Accepted Answer

The answer of An electronic claims process is more efficient...

Question 3

The out-of-pocket payment amount that a policyholder must meet before insurance coverage begins is called the

Accepted Answer

The deductible is the out-of-pocket payment amount that a policyholder must meet before insurance coverage begins.

Question 4

Explain the factors that are taken into account when assigning an evaluation and management (E&M) code.

Accepted Answer

The answer of Explain the factors that are taken into...

Question 5

Daniel Burke, a patient of Dr. Etherington, had a minor procedure performed in the office on May 5. His insurance paid a portion of Dr. Etherington's bill, but the insurance company denied payment for the procedure itself. Because of an administrative error, the office is not holding Mr. Burke responsible for the balance. Is it still necessary for that service to be included on the patient's account? Why or why not?

Accepted Answer

The answer of Daniel Burke, a patient of Dr. Etherington,...

Question 6

Citing three examples, discuss how insurance plans differ.

Accepted Answer

The answer of Citing three examples, discuss how insurance plans...

Question 7

Explain the fee-for-service reimbursement system as it compares to the reimbursement model used as a result of the Affordable Care Act (ACA).

Accepted Answer

The answer of Explain the fee-for-service reimbursement system as it...

Question 8

The process of reviewing claims to determine payment is called

Accepted Answer

Adjudication is the process of reviewing claims to determine payment in the healthcare industry.

Question 9

All of the insurance companies and the individual plans of patients in a medical practice are included in what database of the practice's practice management software?

Accepted Answer

The answer of All of the insurance companies and the...

Question 10

Mrs. Lam was sent from her doctor's office to the outpatient laboratory for a urinalysis. Her insurance company denied the claim, stating that the procedure was not necessary. The healthcare professional reviewed the claim and saw that a urinalysis was ordered, and the diagnosis listed on the encounter form was upper respiratory infection. Why was this claim denied?

Accepted Answer

The answer of Mrs. Lam was sent from her doctor's...

Question 11

Some insurance plans will pay for certain services and some will not. Explain this concept and give an example.

Accepted Answer

The answer of Some insurance plans will pay for certain...

Question 12

A formal, written document that describes how a physician's practice or hospital ensures that rules, regulations, and standards are being adhered to is known as what kind of plan?

Accepted Answer

The answer of A formal, written document that describes how...

Question 13

Jeannie Lopez has never been seen in Greensburg Medical Center. The evaluation and management code assigned will be based on the fact that she is a/an ___________ patient.

Accepted Answer

The answer of Jeannie Lopez has never been seen in...

Question 14

Explain why the health record is the source document for coding diagnoses and procedures.

Accepted Answer

The answer of Explain why the health record is the...

Question 15

The charge for each service (by CPT code) provided in a medical practice is known as the fee ________________.

Accepted Answer

The answer of The charge for each service (by CPT...

Question 16

Why was it necessary to convert from ICD-9 to ICD-10?

Accepted Answer

The answer of Why was it necessary to convert from...

Quiz 6: Financial Management: Insurance and Billing Functions