Chapter 3 Test Flashcards
If your clinic has patients that do not show for their scheduled appointments it would be good clinical practice to:
(A) Not schedule them again.
(B) Make reminder calls 1-2 days in advance.
(C) Double book all appointments.
(D) Charge for the visit.
(B) Make reminder call 1-2 days in advance.
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 no appropriate as a face-to-face encounter with the patient is required for this service.
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 husband’s insurance because of the birthday rule.
(B) The patient’s insurance because she is the primary subscriber.
(C) The husband’s insurance is primary because he is the head of the household.
(D) Either can be filed as primary.
(B) The patient’s insurance because she is the primary subscriber.
When a patient has insurance where they are the subscriber, this coverage is primary. The birthday rule applies only when both parents provide insurance coverage.
When a fee ticket (encounter form) is not completed, what procedure would NOT be acceptable?
(A) Complete the form based on medical record documentation.
(B) Query the provider for the procedure/service and diagnosis.
(C) Post the service as a no charge.
(D) Return the form to the provider for completion.
(C) Post the service as a no charge.
The encounter form is used for the provider to relay to the charge entry staff what services or procedures were performed during that visit and why they were performed. If nothing is complete, the provider should be queried or the encounter coded from the medical record. Posting a no charge could result in the loss of revenue for the practice. Return the fee ticket to the provider or inquire what services should be billed. Completing the form based on documentation would also be an option.
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 an online registration.
(D) Patients can provide information by completing a paper form or by completing an online registration.
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 in the event of data entry errors. Registration forms may be completed on paper or via an online registration form.
In what circumstances would the checkout process be unnecessary?
(A) The patient made a copay during the check-in process and no follow-up appointment is necessary.
(B) The patient needs to make a follow-up appointment.
(C) The patient had a procedure performed in addition to the E/M and need to return in a week.
(D) The patient has services performed that are not covered by the insurance.
(A) The patient made a copay during the check-in process and no follow-up appointment is necessary.
The discharge process is also called a check-out. This is done after the patient has been seen by the provider. The receptionist should review the encounter form to make sure it has been completed. If the copayment was not collected at check-in, it should be collected at check-out. Any deductibles and payment for services that are not covered bu insurance should also be collected. If the patient needs a follow-up appointment, it can be done so during the check-out process. Additional procedures or services not covered by the insurance carrier may require additional copay or deductibles to be collected. If a patient requires a follow-up appointment check-out would be necessary.
Which of the following represent a typical Blue Cross ID number?
(A) 123456789B.
(B) GHURWK45.
(C) FEP555223113.
(D) M106325.
(C) FEP555223113.
BCBS ID numbers are typically 3 letters followed by a 9-digit number.
When insurance coverage is being verified, which of the following is NOT a method on which to rely?
(A) Phone.
(B) Internet.
(C) Patient.
(D) Clearinghouse.
(C) Patient.
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 ad may contain notes from the payer such as patient not eligible for the date of service. Best practice would NOT be to rely on patient knowledge of their coverage.
The type of coverage that a patient has and what services are covered is defined as the patients insurance_______?
(A) Benefits.
(B) Deductible.
(C) Co-insurance.
(D) Out-of-network.
(A) Benefits.
The definition of benefits is the type of coverage that a patient has, whether medical, dental, or vision.
When entering patient data into a PMS:
(A) Assume the information is correct.
(B) Enter the patient information accurately from the insurance card and patient registration form.
(C) Review the information annually for correctness.
(D) The format of the information is not important but must be entered.
(B) Enter the patient information accurately from the insurance card and patient registration form.
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.
How do most practices submit claims to the insurance company?
(A) Directly from the the PMS to the insurance carrier.
(B) Through a clearinghouse.
(C) Through a claims analyzer.
(D) By hiring a claims adjudicator.
(B) Through a clearinghouse.
Each practice can submit claims either directly to the insurance carrier or through a clearinghouse. Most practices utilize the services of a clearinghouse to submit claims instead of submitting the claims directly to the payer.
What process would NOT be performed at the check-out process?
(A) Follow-up appointments.
(B) Collection of copays or deductibles.
(C) Review of charge ticket or encounter form.
(D) Patient registration process.
(D) Patient registration process.
Patient registration should be completed at the start of the visit, or at check-in. Copays and deductibles can be collected at check-in or check-out.
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 appointments schedule.
(D) Posting charges and payment in different batches with no balancing.
(D) Posting charges and payment in different batches with no balancing.
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.
Commercial insurance is typically offered or provided by:
(A) An employer.
(B) Medicare.
(C) Medicaid.
(D) TRICARE.
(A) An employer.
A commercial health insurance plan or private health insurance plan is health insurance that is not offered and managed by a government program. Commercial insurance can be a group insurance plan which if 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.
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) $15.00.
(B) $61.40
(C) $13.60.
(D) $10.00.
(C) $13.60
Policy pays 80% of $68.00 (contracted amount) with 20% of $68.00 being patient responsibility, $13.60.
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) Authorization to Disclose Health Information.
(B) Consent for Payment.
(C) Consent for Treatment.
(D) Patient Information Form.
(A) Authorization to Disclose Health Information.
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.
