Which of the following is an appropriate way to open the discussion when explaining practice fees to a patient?
a. "Do you have any questions about the
... [Show More] cost of today's visit?"
b. We can accept your insurance as payment in full."
c. "Do you know what your out of pocket cost is today?"
d. "We will bill you for the visit in full." - ✔✔ A. "Do you have any questions about the cost of today's visit?"
Which of the following information should be used to capture charges from an encounter form?
a. provider participation status
b. patient's insurance benefits
c. past procedures and scheduled future visits
d. services rendered and reason for visit - ✔✔ d. services rendered and reason for visit
When posting transactions for electronic claims submission, it is necessary to enter which of the following items onto the claim?
a. insurance plan's allowable fee
b. physician's office fee
c. insurance plan's UCR fee
d. physician's contractual fee - ✔✔ b. physician's office fee
The patient is sent a statement for an office visit. The total amount of the bill is $100.00 and this amount must be paid before the insurance company will pay on the claim. Which of the following is this called?
a. deductible
b. premium
c. copayment
d. coinsurance - ✔✔ a. deductible
When posting an insurance payment via an EOB, the amount that is considered contractual is the:
a. co-insurance
b. NON-PAR payment allowable
c. patient responsibility
d. insurance allowed amount - ✔✔ d. insurance allowed amount
Developing an insurance claim begins
a. when the patient calls to schedule an appointment
b. once the charges have been entered into the computer
c. when the patient arrives for the appointment
d. after the medical encounter is completed - ✔✔ a. when the patient calls to schedule an appointment
When should a provider have a patient sign an ABN?
a. when a service is excluded from coverage under Medicare
b. when the items may be denied and prior to performing the service
c. when the service is covered under Part B fee schedule
d. prior to treating a patient who requires emergency services that might not be covered - ✔✔ b. when the items may be denied and prior to performing the service
Which of the following regulations prohibits the submission of a fraudulent claim or making a false statement or representation in connection with a claim?
a. Stark Law
b. Federal Claims Collection Act
c. Federal False Claims Act
d. Anti-kickback Law - ✔✔ c. Federal False Claims Act
The patient's total charges are $300. The allowed amount is $150. Benefits pay 60%. Which of the following will the patient have to pay?
a. $60
b. $90
c. $150
d. $180 - ✔✔ a. $60
Which of the following process makes a final determination for payment in an appeal board?
a. deposition
b. peer to peer
c. special handing
d. arbitration - ✔✔ d. arbitration
Which of the following items are mandatory in patient financial policies? (Select the three (3) correct answers.)
a. participating insurance companies
b. provider fee schedule
c. statement that responsibility for payment lies with patient
d. collection process
e. expectation of payment due at time of service - ✔✔ c. statement that responsibility for payment lies with patient
d. collection process
e. expectation of payment due at time of service
Collections agencies are regulated by the
a. Outpatient Prospective Payment System
b. Health Care Finance Administration
c. Uniform Bill of 2004
d. Fair Debt Collections Practices Act - ✔✔ d. Fair Debt Collections Practices Act
In order to have claims paid as quickly as possible, the insurance specialist must be familiar with which of the following?
a. Automated claims status requests
b. clearinghouse processing procedures
c. prompt pay laws
d. payer's claim processing procedures - ✔✔ d. payer's claim processing procedures
Which of the following are violations of the Stark Law? (Select the two (2) correct answers)
a. accepting gifts in place of payment from patients
b. referring patients to facilities where the provider has a financial interest
c. upcoding
d. negligent handling of protected health information (PHI)
e. billing for services not rendered - ✔✔ a. accepting gifts in place of payment from patients
b. referring patients to facilities where the provider has a financial interest
HIPAA allows a health care provider to communicate with a patient's family, friends, or other persons who are involved in the patient's care regarding their mental health status providing
a. the patient is not incapacitated
b. a second physician signs off on the disclosure
c. the patient does not object
d. psychotherapy notes are used for further treatment - ✔✔ c. the patient does not object
The insurance and coding specialist calls a carrier to verify a patient's insurance and the representative states that the patient insurance was canceled three months ago. Which of the following should the insurance and coding specialist do first?
a. ask the patient for another form of insurance coverage
b. discuss self-pay options with the insurance policy holder.
c. ask the patient to reschedule the appointment
d. record the information and refer the patient to another provider - ✔✔ a. ask the patient for another form of insurance coverage
When using an EHR system to enter CPT codes on a CMS 1500 claim form for electronic submission, which of the following should be entered on the claim form first?
a. the most resource-intensive procedure or service
b. the first code selected on the electronic superbill
c. any HCPCS code
d. the least expensive procedure or service - ✔✔ a. the most resource-intensive procedure or service
Which of the following is the correct procedure for keeping a Workers' Compensation patient's financial and health records when the same physician is also seeing the patient as a private patient?
a. Separate financial and health records must be used.
b. the same health record may be used, but a separate financial record must be maintained
c. the same financial and health records may be used
d. the same financial record may be used, but a separate health record must be maintained - ✔✔ a. separate financial and health records must be used
Which of the following protects federal healthcare programs from fraud and abuse by healthcare providers who solicit referrals?
a. Federal Claims Collection Act
b. Utilization Review Act
C. Fraud and Abuse Act
d. Anti-Kickback Statute - ✔✔ c. Fraud and Abuse Act [Show Less]