Chapter 3 - Patient Encounters and Billing Information
1. In what format does an encounter form come a. PDA only b. paper only c. Electronic only d. Paper and/or electronic
D
1. An established patient is defined as one who has seen the provider within the last a. Four years b. Three years c. Two years d. One year
B
1. Sometimes the use of a third payer is necessary after wo health plans have made payments on a claim. This type of insurance is known as a. Supplemental insurance b. Tertiary insurance c. Secondary insurance d. Primary insurance
B
1. When should the insurance specialist update the encounter form a. Every six months b. Every week c. When codes change d. Every month
C
1. Which HIPAA transaction is used to send information from a primary payer to a secondary payer a. Claim status b. Eligibility for a health plan c. Coordination of benefits d. Health care payment
C
1. pick the type of use of PHI that a practice would employ to discuss a patients case with another provider a. health care operations b. patient information form c. treatment D. payment
C
1. the initial step in establishing financial responsibility is to a. issue patient statements b. assign the medical codes c. verify the payer's rules for the medical necessity of the planned service d. complete the patient ledger
C
1. what type of number is assigned to a HIPAA 270 electronic transaction a. transaction number b. payer number c. trace number d. identification number
C
1. what type of provider is required to have patients sign an acknowledgement a. pathologist b. indirect provider c. direct provider testing center
C
1. which HIPAA transaction is used to check patients' insurance coverage a. health care payment b. coordination of benefits c. eligibility for a health plan d. claim status
C
1. Which of the following is another common term for encounter forms a. Charge slips b. Routing slips c. Superbills d. All of these are correct
D
1. what type of information is not found on an insurance card a. group identification number b. member identification number c. member name d. the date the policyholder first paid a premium
D
1. A patient has just seen the physician and received two different covered services that normally require copayments. Determine how the payment should be handled a. If the health plan permits multiple copayments, both should be collected b. More than one copayment can never be collected; the patient need only pay one c. If the health plan permits multiple copayments, one is collected at the time of service, and the other is collected the next time the patient visits the practice for an encounter d. None of these are correct
A
1. A patient with no previous balance presents for an encounter and wants to know what their bill will be. Calculate the patients estimated balance if they will receive a service worth $127 and a $15 copayment will be collected at time of service a. $112 b. $142 c. $127 d. $15
A
1. Another term for the insured is a. Subscriber b. Parent c. New patient d. Established patient
A
1. Charging TOS payments depends on a. The provision of a patient's health plan and practice's financial policy b. The practice's financial policy c. The provisions of a patient's health plan d. Whether the office allows TOS payments
A
1. Determine by which of the following means a practice may receive a "self-refer" a. The patient comes for specialty care without a referral number when one is required b. The patient requests a referral number from their physician and gives it to the practice c. The patient cannot self refer d. The patient is issued a referral number from their health plan
A
1. Financial polices usually contain the following information a. Credit policy, insufficient funds payment policy, and insurance information b. Insufficient funds payment policy and TOS collection c. Insurance information and insufficient funds payment policy d. Credit policy and insurance information
A
1. Identify a situation in which insurance is checked after encounter a. A medical emergency occurs b. An established patient visits the office c. A new patient visits the office d. The encounter is for a yearly check-up
A
1. Identify the factor that does not determine a patient's copayment a. The length of time the patient has been seeing the practice b. Whether the provider is in the patient's network c. The type of service d. None of these
A
1. Identify the information that is not typically included on an encounter form a. The patient's plan benefits b. A checklist of managed care plans under contract and their utilization guidelines c. The patient's prior balance, if any\ d. Check boxes to indicate the timing and need for a follow-up appointment to be schedules for the patient during checkout
A
1. To make sure that all patients can follow the financial policy, it should be a. Displayed on the wall of the reception area or included in new patient information packet b. Displayed on the wall of reception area only c. Displayed on a wall in exam rooms only d. Included in new patient information packet only
A
1. Under medicare, what must a provider receive before they are permitted to collect a deductible or any other payment a. Data on how the claim is going to be paid b. Authority to accept assignment c. The patient's coinsurance d. The patient's copayment
A
1. What are the procedures that ensure billable services are recorded and reported for payment called a. Charge capture b. Coordination of benefits c. Documentation d. Communications
A
1. What does COB stand for in medical insurance terms a. Coordination of benefits b. Collection of businesses c. Collection of benefits d. Coordination of businesses
A
1. What does a provider complete during or just after a patients visit to summarize their billing information a. Encounter form b. Referral c. Information sheet d. Progress report
A
1. What information does RTA allow the practice to view a. The amount the health plan will pay and amount patient will owe b. The amount the patient will owe c. The amount the health plan will pay d. RTA does not have anything to do with payment
A
1. What is another name for the HIPAA eligibility for a health plan transaction a. X12 270/271 b. X12 837 c. ABN d. X12 278
A
1. What means are available for completing an encounter form a. Paper forms b. Laptops c. Tablets d. All of these are correct
A
1. What process is used to quickly generate the amount a patient owes a. Real-time adjudication b. Estimating what a patient owes c. Making financial arrangements d. Both real-time adjudication and making financial arrangements
A
1. What provision explains how insurance policies will pay if more than one policy applies a. Coordination of benefits b. Birthday rule c. Gender rule d. Custody rule
A
1. When a provider asks a health plan for approval of a service, the response is known as the a. X12 278 b. X12 837 c. X12 271 d. X12 270
A
1. Which of the following is gathered via the patient information form a. The patient's personal and insurance information b. The patient's examination results c. The patient's discharge summary d. The patient's progress notes
A
1. Which of these documents will the patient not compete a. Encounter form b. Medical history c. Patient information form D. Assignment of benefits
A
1. Who typically documents the patient's vital signs a. Clinical medical assistant b. Physician c. The payer's representative d. The front desk person
A
1. a provider such as a facility who does not have face-to-face interaction with a patient is called a(n) a. indirect provider b. physician assistant c. direct provider d. incident-to provider
A
1. examine the types of information below and determine which type is NOT important to collect from a new patient a. availability for future appointments b. preregistration and scheduling information c. medical history d. patient/guarantor and insurance data
A
1. in recording a patient's name when sending it to a payer, what version of their name should be used a. their name as it is shown on the insurance card b. their name as it is shown on the assignment of benefits form c. the name or nickname that they go by d. their name as it appears on the patient information form
A
1. the document patients sign to signify that they have read and understood how the provider will protect their PHI is the a. acknowledgment of receipt of notice of privacy practices b. patient information form c. assignment of benefits D. medical history form
A
1. what does an acknowledgment of receipt of notice of privacy practices state a. that the patient understands how the provider intends to protect their rights to privacy under HIPAA b. that the doctor will contact the patient if insurance company wants medical records c. the medical records cannot be released without consent for any reason d. that the patient understands the practice's financial policy
A
1. what should be verified when someone requests PHI for TPO purposes a. the identity of the person and person's authority to access PHI b. the person's authority to access PHI and signed acknowledgement of receipt of notice of privacy practices c. signed acknowledgement of receipt of notice of privacy practices d. the identity of the person and signed acknowledgement of receipt of notice of privacy practices
A
1. who should the front desk at a medical office ask about whether any of their pertinent personal or insurance information has changed a. established patients b. new patient c. referring providers d. direct provider
A
1. The practice's rules for payment for medical services are found in their a. Coordination of benefits b. Financial policy c. Documentation d. Compliance plan
B
1. You are working in a practice and a patient for an appointment on November 20, 2018; the patient last visited the practice on March 5, 2014, and is scheduled to see the same physician. Determine what you should ask the patient to do upon arrival a. The patient may see the physician without reviewing their information b. Complete all required forms before their first encounter with the provider c. Review and update the information that is on file about them d. Call insurance company to verify coverage
B
1. a provider who directly treats a patient is called a(n) a. incident-to-provider b. direct provider c. indirect provider d. physician assistant
B
1. what type of information is included in a patient's social history a. exercise habits and referring physician name and number b. smoking, alcohol use, and exercise habits c. alcohol use and social security number d. insurance information and patient address
B
1. where is an assignment of benefits statement filed a. patient medical records only b. patient medical records and patient billing records c. patient billing records only d. sent to the insurance company
B
1. What type of charges do practices routinely collect at the time of service a. Copayments or coinsurance and noncovered only b. Noncovered or overlimit fees and self-pay patients only c. Copays, noncovered, and self-pay patients d. Charges for self-pay patients only
C
1. What type of questions should physicians be asked regarding billing and coding a. Basic b. Basic and essential c. Essential d. None of these are correct
C
1. When the practice can get answers quickly from insurance plans, it will benefit from a. More payments for services b. Larger payment for services c. Quicker payment for services d. All of these are correct
C
1. Which of the following is used to send necessary data to payers for a claim a. X12 270 b. X12 271 c. X12 837 d. X12 278
C
1. You are working at a practice and have been asked to document some payer communications. Determine where the communications should be recorded a. Clinical record b. Medical record c. Financial record d. Encounter form
C
1. eligibility for Medicaid may change as quickly as a. daily b. weekly c. monthly d. yearly
C
1. patients who elect to pay a higher copayment, greater coinsurance, or both, are most likely visiting a a. PAR b. Provider in network c. nonPAR d. primary care doctor
C
1. pick the type of use PHI that a practice would employ to submit claims on behalf of a patient a. health care operations b. patient information form c. payment D. treatment
C
1. what is set up in the practice management program when a patient's chief complaint is different than the one for a previous encounter a. chart number b. identification number c. new case d. none of these are correct; nothing needs to be set up
C
1. A "self-pay" patient is one who a. Is not the policyholder b. Is a dependent of a policyholder c. Owes a copayment d. Is uninsured
D
1. A patient's insurance card usually shows a. The date the policyholder first paid a premium or copayment b. The name of the payer's representative c. The former employer's name d. Member identification number
D
1. Another term for prior authorization is a. Supplemental b. Self-pay c. Referral waiver d. Certification
D
1. For unassigned claims, the payment for services rendered is expected a. After the insurance is billed b. When the claim is sent c. After the patient receives a statement d. At the time of service
D
1. If a provider has agreed to accept assignment, he/she will a. Bill the patient for any amount not paid by the payer b. Write oof the copay/coinsurance c. Write of the deductible d. Accept the payer's allowed charge as payment in full
D
1. If the practice accepts credit and debit cards it must a. Agree to accept the allowed amount as payment in full from the insurance company b. Wait until the claim has been processed to charge the credit card c. Accept a discount from the patient on their bill d. Pay a fee to a credit card company
D
1. In what order are benefits typically determined when the parents do not have joint custody arrangements a. Plan of custodial parent and then plan of spouse of custodial parent only b. Plan of parent without custody, plan of custodial parent, plan of spouse of custodial parent c. Plan of parent without custody only d. Plan of custodial parent, plan of spouse of custodial parent, plan of parent without custody
D
1. Ms. Lowell arrives for an appointment on February 8, 2017. She last visited the practice on May 14, 2016, and is scheduled to see the same physician. What should you, medical office receptionist, ask Ms. Lowell to do upon arrival a. Just have a seat and with for the physician b. Call her insurance company to verify coverage c. Complete all forms required for new patients d. Review and update the information on file, in case there are changes
D
1. Under what rue is a child's primary coverage determined based upon which parent's day of birth is earlier in the calendar year a. Parent rule b. Gender rule c. Custody rule d. Birthday rule
D
1. Under what rule is a child's primary coverage under the father's plan when both parents have coverage a. Custody rule b. Birthday rule c. Parent rule d. Gender rule
D
1. What is the process when you can create a claim while the patient is being checked out and receive an immediate response from the payer a. TPO b. POS c. TOS d. RTA
D
1. What must patients who are members of CDHPs do before their health plan makes a payment a. Self-bill their health plan b. Allow the provider to accept assignment c. Pay their coinsurance d. Meet a large deductible
D
1. You are working at a practice, and need to get prior approval from a payer. Which of the following HIPAA transaction would you use to do so a. Coordination of benefits b. Health care payment c. Eligibility for a health plan d. Referral certification and authorization
D
1. a patient presents for an appointment, and you must locate the information about their health plan. determine where this information should be located a. patient's insurance card only b. patient's signed acknowledgement of receipt of notice privacy practices c. patients health survey and patient information form d. patient's information form and insurance card
D
1. determine who a policyholder can authorize physicians to submit claims on their behalf and receive payments directly from payers a. providing a coy of their driver's license b. completing the patient information form c. providing a copy of their insurance card d. signing and dating an assignment of benefit statement
D
1. identify the person/entity that must authorize providers to release a patient's PHI for TPO purposes a. the health plan b. the patient c. the physician d. none of these; they do not need authorization
D
1. patient will have the same chart number when a. they have the same name b. they are minors c. they share the same guarantor d. none of these; chart numbers are unique
D
1. pick the type of use of PHI that a practice would employ to train their staff to improve the quality of their health care a. payment b. patient information form c. treatment d. health care operations
D
1. what can be used to verify insurance company information a. notice of privacy practice b. TPO c. Patient information form d. Portal
D
1. Identify the best time during which to begin collecting patient information a. Billing process b. Verification process c. Coordination of benefits d. Process e. Preregistration process
E
1. A new patient is defined as one who has NOT seen the provider with the last a. Four years b. Three years c. One year D. Two years
B
1. After one health plan has paid on a claim, which insurance makes the next payment, if applicable a. Tertiary insurance b. Secondary insurance c. Disability insurance d. Primary insurance
B
1. An RTA generates a. An estimate on the amount the patient will owe b. The actual amount the patient will owe c. An estimate on the amount the payer will send d. RTA does not generate these services
B
1. Assignment of benefits authorizes a. the payer to send payments directly to the patient b. the physician to file claims for a patient and receive direct payments from the payer c. the physician to give patients completed claim forms to send to payers d. none of these are correct
B
1. Determine which of the following entities would be given a referral number a. The health plan b. The referred physician c. The referring physician d. The patient
B
1. For assigned claims, the payment for services rendered is expected a. At the time of service b. After the patient receives a statement c. When the claim is sent d. After the insurance is billed
B
1. Identify the means by which practices can be sure that all visits have been entered in the practice management program a. Examination b. Prenumbering c. Superbills d. All of these are correct
B
1. If a patient has coverage under two insurance plans, one under which the patient is the policyholder and one under which the patient is a dependent, the primary plan is: a. The plan in effect for the patient the longest b. The patient's plan c. The spouse's plan d. Either plan, depending on coverage
B
1. If an employed patient has coverage under two insurance plans, one from a current employer and one from a previous employer, the primary plan is a. The previous employer's plan b. The current employer's plan c. The plan in effect for the patient the longest d. Either plan, depending on coverage
B
1. If an employed patient has coverage under two insurance plans, one the employer's plan and the other a government plan, the primary plan is: a. The government plan b. The employer's plan c. The plan with the lowest premium d. The plan in effect of the patient the longest
B
1. NonPAR stands for a. Nonparticular b. Nonparticipating c. Noncovered d. Participating
B
1. A patient arrives for an appointment and you need to locate his insurance information. You would use which of the following documents to find it a. Acknowledgment of receipt of privacy practices b. Medical history form c. Patient information form D. Notice of privacy practices
C
1. Describe what should be done when incorrect or conflicting data re discovered on encounter forms a. Call the health plan b. Send in without correcting and then appeal when rejected c. Double-check the documentation and communicate with the physician d. Nothing needs to be done
C
1. If a patient authorizes a provider to accept assignment, what can the provider now do on their behalf a. Receive payments directly from the payer and provide treatment for a self-pay patient b. Provide treatment for a self-pay patient only c. File claims for the patient and receive payments directly from the payer d. Receive payments directly from the payer only
C
1. If a patient has coverage under two insurance plans, the primary plan is the one that a. Pays the largest benefit b. Is a government plan c. Has been in effect for the patient the longest d. Has the largest deductible
C
1. If a retired patient with medicare also has coverage under a working spouse's plan the primary plan is a. Medicare b. The plan in effect for the longest spouse's plan c. The spouse's plan d. The plan with the lowest premium
C
1. Patients may have fill-in-the-gap insurance called a. Primary insurance b. Secondary insurance c. Supplemental insurance d. None of these are correct
C
1. The first health plan to pay when more than one plan is in effect is called the a. Secondary insurance b. Supplemental insurance c. Primary insurance d. Tertiary insurance
C
1. The terms "subscriber" and "guarantor" have the same meaning as a. Guardian b. Established patient c. Insured D. New patient
C
1. Under a coordination of benefits provision, when should any additional coverage be reported to the primary payer a. Reported only if you are participating provider with the secondary insurance b. It is not required to be reported at all c. Reported only if the patient has signed an assignment of benefits statement d. Reported only if you are participating provider with both insurance companies
C
1. What do payers issue when they approve a service a. Self-referral b. Referral waiver c. Prior authorization number d. Trace number
C
1. What information must be documented in the patient's financial record when communicating with payers a. The dare of communication and the outcome b. The representative name and date of communication c. The representative's name, date of communication, and outcome d. Nothing should be documented in the financial record
C
1. What medicare form is used to show charges to patients for potentially non-covered services a. Assignment of benefits b. HIPAA X12 270/271 c. Advance beneficiary notice d. Acknowledgment of receipt of notice of privacy practices
C
