Test 2 dental office management

What should the administrative dental assistant say when a patient who owes for services asks to speak with the dentist?

"The dentist put me in charge of this matter"

The dental assistant must use which of the following when reporting dental procedures and filing insurance forms?

Code on the Dental Procedures and Nomenclature

When a patient has a long outstanding debt to the dental office, what is the most effective method of collection?

Collection telephone call.

Under _______, a subscriber has the option to continue coverage if he or she changes jobs, is laid off, or retires.

Consolidated Omnibus Budget Reconciliation Act (COBRA)

According to the Fair Debt Collection Practice Act, what is not allowed when collecting a debt?

Contacting the patient's employer for reasons other than verifying employment or residence, telephoning the debtor at unreasonable hours, threatening violence, and using false pretenses to get information.

Under COB, the patient may receive payment from two carriers, but the total may not be more than ___% of the expenses.

100%

What are examples of dental insurance fraud?

Changing fees to obtain a higher payment, accepting more payment than what was billed, and billing for services not provided.

What form is used to transmit information from the treatment area to the business office?

Charge slip

Is it the responsibility of the business assistant to create a financial protocol for the office?

No it is up to the dentist.

Under government programs, the DDS must accept the amount paid by the carrier as payment in full; according to:

Fixed Fee Schedule

Copayment

A fixed amount of money that the patient is required to pay under certain dental plans at the time that the procedure is performed

Predetermination

A recommended treatment must be approved bythe insurance plan before the services are performed to ensure that the patient isable to afford the service

Annual Maximum

A set amount of money that the insurance will pay for services within the course of a year either for an individual or a family.Any amount of money that exceeds the fixed amount for the year, the patient is responsible for paying for. This same concept goes for lifetime maximums as well.

Walkout Statement

A walkout statement is similar to a receipt, except it shows the current account balance so that the patient has a reference of what they still owe or do not owe as they are leaving the dental office.

_______ is the means or process of recording, classifying, and summarizing financial transactions.

Accounting

Monies owed to the practice are termed:

Accounts receivable

Adjustments to an account

Adjusting an overpayment to an account, an NSF check, or a small write off when a DDS participates with insurance.

What are the deterrents to fraudulent insurance billing?

An assistant cannot escape liability for insurance fraud by claiming it was the dentist's idea and pleading ignorance. It is the business assistant's responsibility to recognize fraud and only submit accurate and honest insurance claims or they will be liable for the fraud.

When should the Truth in Lending form be given to the patient?

Before a payment plan of more than four monthly payments is set up.

What are the different means of treatment that a patient can use in his/her account?

Cash, card, check, digital wallet, or insurance.

_________ fee is witching the range of the usual fees for the same service by DDS within similar training, in the same area.

Customary

In the procedure code D4987, which digit identifies the code as a dental service code?

D

After the ______ has completed the case presentation, the ______ may be asked you handle the discussion of the fees involved.

Dentist, Business Assistant

What does a patient have if he or she has dental coverage under more than one dental plan?

Dual coverage

What document should be review prior to members of the healthcare team making collection telephone calls?

Fair Debt Collection Practices Act

Reasonable

Fee justified by special circumstances necessitating extensive or complex treatment

Describe how you would discuss financial arrangements with a patient.

Financial arrangements must be made before a procedure is performed in order to reduce the risk of the patient not paying for the treatment because it ended up being more than they could afford. You would need to figure out what forms of treatment the patient's insurance will and will not cover to give them options. You would need to determine if they are able to pay for the treatment in full or if a payment plan will need to be initiated. Once an arrangement is made, a contract must be signed for the agreed upon price. This will all need to have been done in a private setting.

Formulate a good response for the following excuse: "I can wait to make this payment; dentists don't report late payments to credit agencies."

It is true that dentists do not report late payments to credit agencies, but payment is still required within the amount of the agreed upon time specified in your statement. Although you won't face any consequence credit-wise, it is still necessary for you to make your payment on time or further action can be taken.

What statement is correct about dental insurance?

Major source of practice income.

What terms is used to describe an amount the patient is responsible for paying, such as coinsurance or copayments, deductibles, and costs above the annual maximum?

Out of pocket expenses

In dental insurance terminology, how would dependents be described?

Parties covered under another person's dental benefits policy.

Before treatment, what can be submitted to the insurance to request information on what the insurance company covers?

Pretreatment Estimate

What is the purpose of a walkout statement?

Reduces the number of statements that must be prepared.

_______ may read "For deposit only to the account of," which allows the check to be deposited only in the company account.

Restrictive Endorsement

What is a requirement for a payment in full plan to work?

Specify the amount patients must pay before treatment.

Who sets the guidelines for fair collections practices?

The Federal Trade Commission with the Fair Debt Collection Practice Act

Deductible

The amount a patient must pay for certain covered services before insurance coverage begins.

Which statement is correct about financial arrangements?

They shoukd be made in an unhurried manner with the responsible party.

How is a customary fee determined?

Third-party administrator determines from actual fees.

Purpose of the patient registration form

To gather all of the basic financial information needed to manage the account history and complete the patient identification portion of an insurance claim form. This will provide the practice with information on the patient's insurance coverage as well which will help to determine which services will be covered and which will not.

Describe the benefits/downsides of small claims court

The benefits of taking a patient to small claims court after they neglected to pay for their treatment by the specified time would be that you would be able to ask for the full amount that is owed for the treatment as well as the court expenses. Itis a way for the practice to finally take a more serious step in obtaining the money that is owed to them. The downside is that even if you do win, it is still up to the practice to collect the amount of the judgement.

What rule determines which carrier is the primary carrier if both parents have insurance to cover a child?

The birthday rule

Provider

The dentist who provides treatment to the patient.

If a dental office does not have a computerized bookkeeping system, what is the manual system called?

The manual bookkeeping system is called pegboard accounting, or a one-writesystem. A daily journal page, ledger card, and carbonized receipt are all positioned so that all the financial records for the visit are written once.

Of the parties involved in dental insurance, who is the carrier?

The party that pays the claims and collects the premiums.

What form needs to be filled out in order to submit information to a patient's insurance company?

The patient identification portion of the patient registration form.

Coinsurance

The percentage a patient must pay for a procedure such as 40% for a root canal and the insurance covers the other 60%.

Bookkeeping

The recording of the accounting process. It involves maintaining records regarding all transactions regarding of collection of fees for dental procedures performed. It also includes keeping records of payments made by the dental office to an outside source.

_______ fee is the fee that a dentist charges for a specific service.

Usual

Describe how you would make collection telephone calls

When placing a collection call, you need to be sure to have all necessary information out ahead of time such as, the exact amount owed, the payment due date, and previous conversation notes. During the call, you must refrain from getting argumentative or defensive no matter what the patient says or does. You must be understanding but firm during the conversation and make note of any agreement that was made over the phone on the account ledger.

Who is the guarantor?

person responsible for payment of the account.

How would a business follow through on collection of fees?

• At 30 days a regular statement with the financial arrangements included will be sent. • At 60 days a second statement is sent along with a phone call. • At 75 days another phone call and more firm collection letter is sent. • At 90 days a third statement is sent with a stronger note or collection letter stating that if the payment is not received in 10 days then the account will be sent over to a collection agency. • At 105 days a telephone call should be sent stating that if it is not paid by a specific date, it will be necessary to turn it over to a collection agency. • At 120 days if no payment or attempt has been made then the account is turned over to a collection agency with the dentist's approval.