Chapter 13-14 / Quiz 7

On an aging report, which category describes a current invoice?

0-30 days

A typical aging report groups payments that are due into which of these categories?

0-30 days, 31-60 days, 61-90 days, and over 90 days

A patient statement is:

A bill that is sent to a patient for medical services that have been provided

RAs generally have information on any:

All of these are correct (adjustments to the listed claims;denials to the listed claims; errors on the listed claims)

_________ is a feature of some medical billing programs that automatically records payments in the correct accounts.

Autoposting

EFT is the abbreviation for:

Electronic Funds Transfer

A Medicare Redetermination Notice explains:

Medicare's unfavorable response to a request for redetermination

Which law requires disclosure of finance charges and late fees for payment plans?

Truth in Lending Act

Which of the following is an example of concurrent care?

a case in which a patient is attended by two physicians, such as a cardiologist and a thoracic surgeon, during surgery

Remittance advice remark codes explain:

adjustments to claims paid on an RA

When is an appeal sent to third-party payers?

after a claim is rejected or paid at less than the expected amount

Financial policies cover which of the following?

all of these are covered (collection of copayments; deductibles; past due balances )

The day sheet in a medical office summarizes:

all the transactions that were posted to all patient ledgers on a particular business day

A payer's initial claim review may reject a claim due to

an invalid policy number

A payer's automated claim edits may result in claim denial because of

any of these (lack of eligibility for a reported service; lack of required preauthorization; lack of medical necessity)

The Medicare Secondary Payer program coordinates the benefits for patients who have both Medicare and

any other insurance coverage

In cycle billing, how often does the practice mail all patient statements?

at intervals during the month

_________ is after an account is determined to be uncollectible and is removed from the practice's expected accounts receivable.

bad debt

__________ is a legal declaration of a person's inability to pay his or her debts.

bankruptcy

If a patient has additional insurance coverage, after the primary payer's RA has been posted, the next step is:

billing the second payer

Which of the following requires a practice to follow a specific series of steps before an account can be written off?

both Medicaid and Medicare

The person filing an appeal is known as a(n) ______________________, regardless of whether that individual is a provider or a patient.

both claimant and appellant

A good financial policy is clear to:

both patients and the practice staff

Who is responsible for regulating the hours during which collection calls may be made?

both the FDCPA and the Telephone Consumer Protection Act

The payer's RA shows:

both the amount the provider is allowed and the amount patient pays

When a payer's RA is received, the medical insurance specialist:

checks that the amount paid matches the expected payments

What kind of code appears on payers' electronic reports on the progress of transmitted claims in their adjudication process?

claim status category codes

When a claim is pulled by a payer for a manual review, the provider may be asked to submit

clinical documentation

To avoid having to bill patients for unassigned claims, most practices:

collect these fees from patients at the time of service

Which of the following functions involves a process to follow up on overdue accounts?

collections

Which of the following employees learns and applies the correct techniques for effective follow-up of overdue accounts?

collections specialist

What does the abbreviation COB stand for?

coordination of benefits

Minor errors found by the practice on transmitted claims require which of the following:

corrections by asking the payer to reopen the claim and make the changes

A payer's decision regarding whether to pay, deny, or partially pay a claim is called

determination

A medical practice may choose to ____________ a rejected or partially paid claim.

either resubmit or appeal

A practice's retention policy for patient medical records must reflect applicable _____________.

federal and state laws

The advantage(s) of EFT for practices is(are)

funds are available immediately and the transfer is less costly than check deposits

If a medical practice believes that it has been treated unfairly by an insurance company, it has the right to file a ____________ with the state insurance commission.

grievance

Patients are grouped under the insurance policyholder in what type of billing?

guarantor billing

Overpayments from Medicare to providers:

have to be repaid within a time specified by Medicare

The claim turnaround time is stated:

in payer's policy manuals or contracts

What is the correct order for the basic steps of a payer's adjudication process?

initial processing, automated review, manual review, determination, and payment.

Prompt-pay laws govern:

insurance carriers' payments of providers' claims

The first step the medical billing specialist should check when reviewing RAs is to:

match up claims with the RA using the unique claim control number

The _________ helps a practice decide whether patients are indigent.

means test

What may result from a lack of clear, correct linkage between the diagnosis and the procedure?

medical necessity denial

From the payer's point of view, ____________________ are improper or excessive payments resulting from billing errors for which the provider owes refunds.

overpayments

The claimant is the:

patient or provider who appeals the claim

What is the term for monies owed to a patient from the provider?

patient refund

Funds that are electronically transferred from a payer are directly deposited in the:

practice's bank account

When patients are scheduled to have major, expensive procedures, the practice's policy may be to set up:

prepayment plans

The process of ________________ means verifying that the totals on the RA are mathematically correct.

reconciliation

The first step in the Medicare appeals process is

redetermination

RA is the abbreviation for:

remittance advice

A ________________ is a log of how long various types of documents must be stored for a particular practice.

retention schedule

HIPAA compliance records must be retained for how many years?

six

The ______________ process is used to locate a patient who owes an account balance to the practice.

skip tracing

Effective patient billing begins with:

sound financial policies

Filing a grievance with the state insurance commission requires the ______ to investigate the complaint.

state

Embezzlement is a form of:

stealing

What is the claim status when the payer is developing the claim?

suspended

The claim turnaround time is the period between:

the date of claim transmission and receipt of payment

An aging report groups unpaid claims or bills according to:

the length of time that they remain due

If the provider has not accepted assignment, the payer sends the payment to:

the patient

If a provider has accepted assignment, the payer sends the RA to:

the provider

Concurrent care is care provided:

to a patient on the same date at the same place of service by two or more physicians

An insurance aging report lists:

unpaid claims

When a practice accepts a credit card payment in advance for payments billed after treatment, what does the practice send the patient?

zero-balance statement