Question 1

What type of state laws mandate a time period within which clean claims must be paid and that call for financial penalties to be levied against late payers?

Accepted Answer

Prompt payment laws are designed to ensure that claims are paid within a specified timeframe, imposing penalties on payers who fail to comply.

Question 2

Payers should be notified ____________ that payment has not been received if a clean claim is not paid within the allotted time frame, according to applicable prompt payment laws.

Accepted Answer

Prompt payment laws typically require that notifications regarding unpaid claims be made in writing to ensure there is a formal record of the communication.

Question 3

Written explanations for all ____________ should be made by practices.

Accepted Answer

All of these situations - claim delays, claim denials, and partial payments - can significantly impact a practice's revenue cycle, and written explanations help in understanding, documenting, and potentially contesting these issues.

Question 4

Which of the following actions should a practice first take if a clean claim is not paid within the allotted time frame?

Accepted Answer

The first step is to notify the payer in writing that payment has not been received, as this establishes a formal record of the issue and initiates communication to resolve the delay.

Question 5

You are working at a practice and realize that a claim has been denied from a payer. What should you request from the payer?

Accepted Answer

A written explanation of the claim denial will provide the specific reasons for the denial, which is necessary to address and potentially rectify the issue.

Question 6

When a clearinghouse receives claims from a physician office, they are __________ against a series of edits.

Accepted Answer

Claims submitted to a clearinghouse are "scrubbed," meaning they are checked against a series of edits to ensure they meet the necessary criteria for processing and payment. This process helps identify and correct errors or omissions before the claims are forwarded to the payer.

Question 7

Which of the following consequences may result from resubmitting rejected claims?

Accepted Answer

Resubmitting rejected claims can lead to increased practice expenses due to the additional administrative work required to correct and resubmit the claims. It can also cause delays in payment as the resubmission process takes additional time, further delaying reimbursement from the insurance company.

Question 8

How many states have enacted prompt payment laws to ensure that claims are paid in a timely manner?

Accepted Answer

Most states have enacted prompt payment laws to ensure that claims are paid in a timely manner, reflecting a widespread legislative effort to protect healthcare providers and policyholders from delayed payments by insurance companies.

Question 9

Your practice has not received a satisfactory payment or explanation from a payer, and has not been able to reach the payer. What is the next step your practice should take?

Accepted Answer

When a healthcare practice faces issues with a payer regarding unsatisfactory payments or lack of communication, notifying the applicable state or federal regulatory agency can be an effective next step. These agencies have the authority to investigate and address such issues, ensuring that payers comply with their obligations.

Question 10

Under the New York Prompt Payment Law, to what is a physician entitled when a managed care organization or insurance company fails to make payment on a clean claim within 45 days of submission?

Accepted Answer

Under the New York Prompt Payment Law, a physician is entitled to interest on the late payment if a managed care organization or insurance company fails to make payment on a clean claim within 45 days of submission.

Question 11

Which of the following is a reason that a payer may use to deny a claim?

Accepted Answer

All of these reasons (services not covered under the contract, services not medically necessary, and services not properly documented) are common grounds for a payer to deny a claim.

Question 12

When further documentation is requested, it should be sent within a specific number of days, per timely _______ requirement.

Accepted Answer

The answer of When further documentation is requested, it should...

Question 13

What is often mandated by state prompt payment laws?

Accepted Answer

State prompt payment laws typically mandate financial penalties against late payers and establish a specific time period within which clean claims must be paid to ensure timely compensation for services rendered.

Question 14

Claims rejected because they do not meet timely filing requirements are the responsibility of the ________.

Accepted Answer

Claims rejected due to not meeting timely filing requirements are typically the responsibility of the provider, as it is their duty to submit claims within the payer's specified time frame.

Question 15

How a practice handles ____________ should be indicated in its financial policy.

Accepted Answer

All of these options (accepting various forms of payment, collecting prepayments, and setting up financial arrangements for unpaid balances) are financial practices that should be clearly outlined in a practice's financial policy to ensure transparency and understanding between the practice and its patients or clients.

Question 16

You are reviewing a list of patients with past-due balances. Several patients have balances that are 45 days past due. What action should you take if your practice is following the suggested patient collection timeline?

Accepted Answer

At 45 days past due, the suggested action is to call patients to remind them of their outstanding balance and discuss payment options.

Question 17

Usually, when a bill has not been paid within ____________ days after it was issued, an automatic reminder notice and a second statement are usually mailed.

Accepted Answer

Typically, a 30-day period is standard for issuing a reminder notice and a second statement for an unpaid bill, as it allows a reasonable amount of time for the initial invoice to be processed and paid by the recipient.

Question 18

Which of the following is a common reason why patients do not pay their medical bills?

Accepted Answer

All of these reasons are common for why patients might not pay their medical bills. Consumer-directed health plans often have high out-of-pocket costs that patients may struggle to afford. Lack of financial resources is a straightforward reason for non-payment. Additionally, some patients may not understand that payment is their responsibility, possibly due to confusion about insurance coverage or billing processes.

Question 19

Which of the following signifies the beginning of the patient collection process?

Accepted Answer

The beginning of the patient collection process involves establishing a clear financial policy and effectively communicating with patients about their financial responsibilities. This foundational step ensures that patients are aware of their obligations and the practice's expectations, setting the stage for smoother financial transactions and collections.

Question 20

Collecting payments is ____________ when patients understand the charges and the practice's financial policy in advance.

Accepted Answer

When patients are informed about the charges and the practice's financial policy beforehand, they are generally more prepared and willing to make payments, leading to fewer issues with collecting payments.

Quiz 9: Collections in the Medical Office