Question 1

A (n) ______ is a patient that has not been seen by the provider within the past three years.

Accepted Answer

A new patient (NP) is someone who has not received any services from the provider (or another provider of the same specialty or subspecialty who is a member of the same practice) within the past three years.

Question 2

A (n) _____ is patient who has been seen a provider within the past three years.

Accepted Answer

An established patient (EP) is a patient who has seen a provider within the past three years. This patient has seen the provider (or another provider in the practice who has the same specialty/subspecialty) within the past three years. Established patients review and update the information that is on file about them.

Question 3

NP is the abbreviation for ____.

Accepted Answer

A new patient (NP) is someone who has not received any services from the provider (or another provider of the same specialty or subspecialty who is a member of the same practice) within the past three years.

Question 4

EP is the abbreviation for _____.

Accepted Answer

Established patient (EP) is a patient who has seen a provider within the past three years.

Question 5

Which of the following is not a type of information that is important to gather when a patient is new to the practice?

Accepted Answer

When a patient is new to the practice, five types of information are important to gather, preregistration and scheduling information, medical history, patient/guarantor and insurance data, assignment of benefits and acknowledgment of receipt of notice of privacy practices.

Question 6

A ____ is the physician who refers a patient to another physician.

Accepted Answer

A referring physician is a physician who refers a patient to another physician.

Question 7

In a managed care organization, a group of providers is called ______.

Accepted Answer

Network is a group of providers in a managed care organization.

Question 8

A provider who agrees to provide medical services to a payer's policyholders according to a contract is called _____.

Accepted Answer

Participating provider (PAR) is a provider who agrees to provide medical services to a payer's policyholders according to a contract.

Question 9

PAR is the abbreviation for ____.

Accepted Answer

(PAR) is the abbreviation for participating provider.

Question 10

A(n) ____ is a provider who does not join a particular health plan.

Accepted Answer

A nonparticipating provider (nonPAR) is a provider who does not join a particular health plan.

Question 11

nonPAR is the abbreviation for ___.

Accepted Answer

nonPAR is the abbreviation for nonparticipating provider who is a provider who does not join a particular health plan.

Question 12

A provider that does not have a participation agreement with a plan is _____.

Accepted Answer

Out-of-network is a provider that does not have a participation agreement with a plan.

Question 13

A form that includes a patient's personal, employment, and insurance company data is called ____.

Accepted Answer

Patient information form is a form that includes a patient's personal, employment, and insurance company data.

Question 14

The policyholder or subscriber to a health plan or policy is called ____.

Accepted Answer

Insured is the policyholder or subscriber to a health plan or policy.

Question 15

Another term for the insured is ____.

Accepted Answer

Subscriber is another word for the insured.

Question 16

A (n) ______ is a person who is the insurance policyholder for a patient.

Accepted Answer

A guarantor is a person who is the insurance policyholder for a patient.

Question 17

_____ is a statement signed by the patient allowing benefits to be paid directly to the provider.

Accepted Answer

Physicians usually submit claims for patients and receive payments directly from the payers. This saves patients paperwork; it also benefits providers, since payments are faster. The policyholder must authorize this procedure by signing and dating an assignment of benefits statement.

Question 18

On a patient insurance card, group identification number is ______.

Accepted Answer

On an insurance card, the group identification number is a number used to identify the member's employer.

Question 19

On a patient insurance card, the plan codes are used for ____.

Accepted Answer

Plan codes are used for claims submissions when medical services are rendered out-of-state.

Question 20

On a patient's insurance card, the number used to identify each plan member is the ___.

Accepted Answer

Identification number is the number used to identify each plan member.

Quiz 3: Patient Encounters and Billing Information