Ch9- Billing Flashcards
Cost-based fee schedules are developed using which of the following
a. RBRVS methodology
b. Total costs of every procedure or service listed in the CPT
c. Total cost of all the procedures the physician will perform
d. Malpractice insurance and office operating costs
c. Total cost of all the procedures the physician will perform
What is the physician payment schedule determined by?
a. The physician
b. The insurance payer
c. The patient
d. The billing office manager
b. The insurance payer
Given the following information:
National conversion factor $33.89
RVU value of $3.26
What is the provider’s fee schedule for 99203 (new patient office visit) using the above values?
a. $110.00
b. $34.00
c. $37.15
d. $74.30
a. $110.00
What will happen if there is failure to post a contractual adjustment to a patient’s account?
a. It will have no effect on the patient’s account balance
b. It will have no effect on the A/R
c. It will leave a balance on the patient’s account that should not be there
d. It will decrease the workload of the billing staff
c. It will leave a balance on the patient’s account that should not be there
Which of the following tasks is the most basic element of the billing process?
a. Claims follow up
b. Status report monitoring
c. Data entry
d. Patient follow up
c. Data entry
What is the function of the claim scrubber?
a. To identify errors that will prevent a claim from being paid
b. To determine the reimbursement amount
c. To determine patient’s deductible amount
d. To identify practice management errors
a. To identify errors that will prevent a claim from being paid
What are payments due from patients, payers, or other guarantors considered to be?
a. Active receivable
b. Accounts receivable
c. Allowed receivable
d. Accounts refundable
b. Accounts receivable
Who is required to obtain a prior authorization for a service or procedure?
a. The parent or legal guardian of a minor
b. The patient
c. The patients insurance payer
d. The physician performing the procedure or service
d. The physician performing the procedure or service
Who generates the remittance advice?
a. The front office reception staff
b. The medical assistant (MA) prior to patient being seen by the provider
c. The medical biller
d. The insurance payer
d. The insurance payer
When a claim has been paid, where is an EOB sent?
a. To the clearinghouse
b. To the patient
c. To the provider
d. To the insurance company
b. To the patient
A patient with ABC insurance is seen on May 1, and the claim is submitted on July 15 of the same year. Has the claim met the timely filing deadline?
a. Yes. All payers have the same timely filing deadline of one year from date of service.
b. No. All payers have a 30-day timely filing deadline.
c. Maybe. ABC’s timely filing policy should be reviewed to determine if the deadline was met.
d. Maybe. Prepare an appeal letter just in case the claim is denied.
c. Maybe. ABC’s timely filing policy should be reviewed to determine if the deadline was met.
To submit claims data through EDI, what format must claim’s data be changed to?
a. Filled files format
b. Flat files format
c. Individual file format
d. Media file format
b. Flat files format
A batch of claims is submitted to the clearinghouse for processing. The status report shows that 20 claims were acknowledged and forwarded on to the payer for payment and 10 claims were rejected. What is the next step the medical biller should take in this situation?
a. Contact the clearinghouse to determine why the 10 claims were rejected.
b. Contact the payer to determine the reason the claims were denied.
c. Notify the billing department manager of the rejected claims.
d. Review the status report to identify the reasons for rejection, make needed corrections and resubmit for payment.
d. Review the status report to identify the reasons for rejection, make needed corrections and resubmit for payment.
When a claim is returned to the provider, at the clearinghouse level, what is it considered to be?
a. Denied
b. Pending
c. Rejected
d. Incomplete
c. Rejected
What is the purpose of EHNAC?
a. To monitor coding practices of providers.
b. To develop standards for insurance payers.
c. To promote interoperability, quality service, and regulatory compliance.
d. To process claims in a timely manner.
c. To promote interoperability, quality service, and regulatory compliance.
The billing department manager reviews the claims paid by HIJ insurance company. This would be considered which type of audit?
a. Pre-payment audit
b. Post-payment audit
c. Coding audit
d. Payer audit
b. Post-payment audit
A physician writes an order for his patient to be admitted to the hospital for observation for suspected dehydration. The patient is observed for 8 hours and discharged to home following hydration therapy. What type of patient is this considered to be?
a. Outpatient
b. Inpatient
c. New patient
d. Established patient
a. Outpatient