CH3- Patient Registration Process/Data Capture

Question 1

Which statement is TRUE regarding appointment reminders?
A. The staff time required for appointment reminders makes it unnecessary to remind patients of upcoming appointments.
B. You must have a HIPAA authorization for release of information to send appointment reminders.
C. Appointment reminders can be sent via text.
D. Appointment reminders do not help mitigate the risk of missed appointments.

Answer 1

C. Appointment reminders can be sent via text.

Rationale: Some of the ways to remind the patient of the appointment is with the following:
Reminder cards - If the patient schedules the appointment in the office, an appointment card can be given
Send reminders - Reminders can be sent by mail, email, or text confirmations to the patient
Phone calls - Phone calls can be made the day before the appointment to confirm the appointment

Question 2

Information about deductibles, copays, eligibility dates, and benefit plans is completed during what step?
A. Patient registration
B. Verification of Benefits
C. Consent for payment
D. Patient check-in

Answer 2

B. Verification of Benefits

Rationale: Verification of benefits provides information concerning the patient’s coverage. This should be performed during the appointment scheduling process and before the patient arrives at the office. This step verifies eligibility effective dates, patient coinsurance, copay and deductible amounts; and plan benefits as they pertain to specialty and place of service. Benefit information allows staff to be informed and ready to collect the appropriate copay, deductible, coinsurance or full balance due at the patient’s visit.

Question 3

A patient wants her results called to her home and states the physician is to talk to her husband. What form should be completed before this is done?
A. Consent for Treatment
B. Authorization to Disclose Health Information
C. Patient Information Form
D. Consent for Payment

Answer 3

B. Authorization to Disclose Health Information

Rationale: Section 164.508 of the HIPAA privacy rule states that covered entities may not use or disclose protected health information without a valid authorization. The Authorization to Disclose Health Information lists the names of the individuals to whom the PHI can be disclosed.

Question 4

Patient types help to classify the patients based on which of the following?
A. Age
B. Payer
C. Address
D. Diagnosis

Answer 4

B. Payer

Rationale: Patient types are established to classify the type of insurance or the payer the patient has.

Question 5

Which statement regarding patient demographic information is correct?
A. The patient does not need to provide all information on the registration form.
B. The patient will always be the responsible party.
C. There is no need for a copy of the insurance card if the patient demographic sheet is completed in its entirety.
D. Patients can provide information by completing a paper form or by completing online registration.

Answer 5

D. Patients can provide information by completing a paper form or by completing online registration.

Rationale: Registration forms must be completed in their entirety. If the patient is a child, the parent(s) or guardian(s) is the responsible party. Maintaining a copy of the insurance card helps the event of data entry errors. Registration forms may be completed on paper or via an online registration form.

Question 6

Patient is seen and billed for a 99213 for $75.00. She has a policy that pays 80% of the allowable amount which is $68.00. What is the patient responsibility and amount to collect for the visit?
A. $10.00
B. $13.60
C. $15.00
D. $61.40

Answer 6

B. $13.60

Rationale: Policy pays 80% of $68 (contracted amount) with 20% of $68 being patient responsibility, $13.60.

Question 7

When reading an insurance card what information should the receptionist or front office person look for?
A. Policy holder name, copay and deductible, patient’s address
B. Policy holder name, copay and deductible, patient’s birthdate
C. Policy holder name, ID number, benefits
D. Policy holder, ID number, address for patient

Answer 7

C. Policy holder name, ID number, benefits

Rationale: Insurance cards are issued to each person covered by the insurance carrier. Although insurances cards come in different sizes, materials, and colors they all contain the same type of information: Policy holder name, Identification Number, Benefits, Pharmacy-RX, Deductible, Copayment, and Coinsurance.

Question 8

A female patient is covered by her employer and her husband’s insurance plan. His birthday is 3/21 and hers is 6/18. Which insurance is considered primary?
A. The patient’s insurance because she is the primary subscriber
B. The husband’s insurance because of the birthday rule
C. The husband’s insurance is primary, because he is the head of the household
D. Either can be filed as primary

Answer 8

A. The patient’s insurance because she is the primary subscriber

Rationale: When a patient has insurance where they are the subscriber, this coverage is primary. The birthday rule applies only to children when both parents provide insurance coverage.

Question 9

Who typically offers or provides commercial insurance?
A. TRICARE
B. Medicaid
C. An employer
D. Medicare

Answer 9

C. An employer

Rationale: A commercial health insurance plan or private health insurance is health insurance that is not offered and managed by a government program. Commercial insurance can be a group insurance plan which is often health insurance through an employer, an individual plan or a personal plan available to those who are willing to pay premiums in exchange for coverage.

Question 10

Which of the following is NOT considered a part of the authorized process when the patient signs the consent for payment?
A. Authorization for treatment
B. Authorize submission of a claim to insurance company
C. Accept responsibility for any balance that is not covered by the patient’s insurance
D. Authorize payment to the provider

Answer 10

A. Authorization for treatment

Rationale: The patient registration form contains patient demographic information and the authorization for payment. Consents for treatment would be handled by clinical staff.

Question 11

If your clinic has patients that do not show for their scheduled appointments, what would be considered a good clinical practice?
A. Charge as if the patient had been seen
B. Double book all appointments
C. Not schedule them again
D. Make reminder calls 1-2 days in advance

Answer 11

D. Make reminder calls 1-2 days in advance

Rationale: No-show appointments cannot be eliminated altogether. However, it is beneficial to make reminder calls 1-2 days in advance. Double booking is not recommended and charging for the visit is not appropriate as a face-to-face encounter with the patient is required for this service.

Question 12

What authorizes information to be sent to the insurance payer so payment of medical benefits can be processed?
A. Chargemaster List
B. Encounter form
C. Consent for payment
D. MSP

Answer 12

C. Consent for payment

Rationale: The consent for payment authorizes information to be sent to the insurance payer so payment of medical benefits can be processed. It also demonstrates responsibility of the patient or responsible party for copayments, coinsurance, deductibles, and fees that exceed the payment made by insurance if the physician does not participate with the patient’s insurance. This agreement must be in writing in order to collect any amount from the patient.

Question 13

A 9-year-old is brought in by her father for a sore throat. The patient has insurance coverage through both the mother and father. Which coverage is considered primary?
A. The primary insurance is determined by the birthday rule
B. The mother’s, because it was effective first
C. The father brought the patient for care, making his coverage primary
D. Both are filed at the same time and the insurance companies sort it out

Answer 13

A. The primary insurance is determined by the birthday rule

Rationale: According to the National Association of Insurance Commissioners, under the birthday rule, the health plan of the parent whose birthday comes first in the calendar year is designated as the primary plan.

Question 14

Which of the following would represent a typical Blue Cross ID number?
A. FEP555223113
B. GHURWK45
C. M106325
D. 123456789B

Answer 14

A. FEP555223113

Rationale: BCBS ID numbers typically have a three-letter prefix, followed by a nine-digit number.

Question 15

The back of the health insurance card includes what information?
A. Copays
B. Phone or contact information for eligibility
C. Group number
D. Primary Care Provider

Answer 15

B. Phone or contact information for eligibility

Rationale: Phone and contact information for eligibility are located on the back of the card.

Question 16

Which of the following processes could result in lost charges?
A. The total of daily charge tickets and the amount posted in the PMS balance
B. Batch dates of service and post as a batch date
C. Balance the charge tickets, copays, and the amounts posted in the PMS with the daily appointment schedule
D. Posting charges and payment in different batches with no balancing

Answer 16

D. Posting charges and payment in different batches with no balancing

Rationale: All batches should balance and provide a process accounting for all charges and payments. Utilize the EMR to assist in tracking missed charges. If paper charge tickets are used, balance to the appointment schedule.

Question 17

When charges are entered and all required components are verified by the claims editing system, what would this be considered as?
A. Denial resolution
B. Claim submission
C. Completed process
D. A clean claim

Answer 17

D. A clean claim

Rationale: A clean claim is described as one that contains the required information based on the payer’s guidelines that is needed to process and pay the claim.

Question 18

Verification of insurance will allow the practice to know the amount to collect from the patient at the time of visit. Which of the following is TRUE?
A. The insurance should be verified with the patient only; it is the patient’s responsibility to know what to pay
B. If the coverage is not in effect the patient should NOT be seen until the coverage can be verified
C. Money should NOT be collected from the patient at the time of the visit.
D. If the insurance is unable to be verified, the patient is offered an option to reschedule the appointment or proceed with the current appointment as a self-pay patient.

Answer 18

D. If the insurance is unable to be verified, the patient is offered an option to reschedule the appointment or proceed with the current appointment as a self-pay patient.

Rationale: The patient’s demographics and insurance information need to be available when verifying the insurance. If the patient is not eligible with the insurance company given, the patient needs to be contacted for updated insurance information. If the patient believes the information is correct and should be covered, the patient should contact the insurance company to have the eligibility files updated. Allow the patient to decide if they want to reschedule their appointment or be considered a self-pay patient and pay for the service out-of-pocket.

Question 19

The group number on the insurance card is used to identify which of the following?
A. The insurance company
B. The covered employer group
C. The insured
D. The policy number

Answer 19

B. The covered employer group

Rationale: The group number identifies the employer group that covers the patient with health coverage.

Question 20

Which of the following is true when entering patient data information into a PMS?
A. The format of the information is not important but must be entered
B. Assume the information is correct
C. Enter the patient information accurately from the insurance card and patient registration form
D. Review the information annually for correctness

Answer 20

C. Enter the patient information accurately from the insurance card and patient registration form

Rationale: Information gathered during the registration process is imperative to the success of a clean claim. If information is entered into the PMS incorrectly, it can result in denied claims or delayed payment. This information should be reviewed, at every visit, for any changes.

Question 21

Which of the following lists the life cycle of a claim?
A. Claims submission, claims processing, claims adjudication, payment/denial
B. Claims submission, claims processing, claims adjudication
C. Claims submission, claim denial, statement sent
D. Claim submission, claims processing, patient payment

Answer 21

A. Claims submission, claims processing, claims adjudication, payment/denial

Rationale: There are 4 steps to the life cycle of a claim which include claims submission, claims processing, claims adjudication, and payment/denial.

Question 22

When insurance coverage is being verified, which of the following is NOT a method on which to rely?
A. Internet
B. Clearinghouse
C. Phone
D. Patient

Answer 22

D. Patient

Rationale: Verification of coverage should be done through the insurance company. Insurance coverage can be verified by phone or by an electronic eligibility verification tool with the insurance company. A clearinghouse report shows when a claim has been received by the payer and may contain notes from the payer such as a patient not eligible for the date of service. Best practice would NOT be to rely on patient knowledge of their coverage.