question

Name provisions seen in health insurance policies

answer

claimant has an obligation to notify company of using benefits; disagreement? you have 3 yrs to file suit; cannot file suit until claim has been submitted for 60 days; insurance company is obligated to pay benefits promptly

question

After an insurance claim is processed by the insurance carrier, what document is sent to the physician?

answer

Explanation of Benefits (EOB)

question

Name other items that indicate the patient's responsibility to pay that may appear on the document explaining payment and check issued by the insurance carrier.

answer

co-payments, deductibles, amount not covered, coinsurance, other insurance payment, analysis of patients total payment responsibility

question

After receiving an EOB document and posting insurance payment, the copy of the insurance claim form is put into a file marked what?

answer

closed claims

question

To locate delingquent insurance claims on an insurance claims register quickly, which column should be looked at first?

answer

date claim paid

question

Name some of the principal procedures that should be followed in good bookkeeping and record-keeping practice when a payment has been received from an insurance company.

answer

Pull all copies of the insurance claims that correspond with the payments and dispose of them; post payment to patients ledger and to the day sheet, deposit check into the bank account

question

In good office management, a manual method used to track submitted pending or resubmitted insurance claims is called what?

answer

A tickler file or a suspense, follow-up file

question

Two procedures to include in a manual reminder system to track pending claims are

answer

Divide claims by month and file active claims chronologically by date of service

question

In making an inquiry about a claim by telephone, efficient secretarial procedure would be to what?

answer

Document date and time of call, name and extension # of who I am speaking to, and outline or briefly note the conversation

question

Denied paper or electronic claims are those denied because of what two reasons?

answer

Benefits coverage issues and program issues

question

State the solution if a claim has been denied because the professional service rendered was for an injury that is being considered as compensable under workers' comp

answer

locate the carrier for the industrial injurt, request permission to treat, send carrier a report of the case with a bill, notify pts health insurance carrier monthly about the status of the case

question

If an appeal of an insurance claim is not successful, the next step to proceed with is what

answer

a peer review

question

What are the five levels of appealing a Medicare claim

answer

Redetermination, reconsideration, administrative law judge hearing, medicare appeals council and federal district court

question

medicare reconsideration by the insurance carrier is usually completed when?

answer

within 30-45 days

question

when an insurance company consistently pays slowly on insurance claims, it may help speed up payments if a formal written complaint is made to whom

answer

state insurance commissioner

question

If the insurance carrier is a self insured plan, a medicaid or medicare health maintenance organization or a ERISA based plan, the insurance commissioner is not able to assist with carrier issues

answer

True

question

A written request made to an insurance company to locate the status of an insurance claim is often referred to as what

answer

an inquiry, follow-up or tracer

question

an insurance claim transmitted to the 3rd party payer that is rejected because it contains a technical error is AKA as a soft denial

answer

true

question

when an electronic claim is transmitted for several services and one service is rejected for incomplete information, the solution is to what

answer

add the required information and retransmit the rejected claim

question

a request for payment to a 3rd party payer asking for a review of an insurance claim that has been denied is called what

answer

appeal

question

If the provider has no contract with the insurance carrier, the provider is not obligated to the carrier's deadline

answer

true

question

a patient should be asked to sighn an advance beneficiary notice if they have decided to undergo plastic surgery that is not related to a medical condition

answer

true

question

an overpayment is receipt of less than the contract rate from a managed care plan for a patient who received medical services

answer

false

question

in the medicare reconsideration level 2 process, the request must be within 9 months form the date of the original determination shown on the R/A

answer

False

question

a decision to appeal a claim should be based on whether there is sufficient data to back up the claim and if there is a large amount of money in question

answer

true

question

Third party payers are composed of ?

answer

private insurance, government plans, managed care contracts, and workers' comp

question

the unpaid balance due from patients for professional services rendered is known as what

answer

accounts receivable

question

an important document htat provides demographic and identifying data for each patient and assists in billing and collection is what

answer

patient registration form

question

a term preferable to \"write off\" when used in a medical practice is

answer

courtesy adjustment

question

to verify a check, ask the pt for what

answer

drivers license and one other form of id

question

the procedure of systematically arranging the accounts receivable by age from the date of service

answer

age analysis

question

physician's patients accounts are considered written contract accounts

answer

false

question

a court order attaching a debtors property or wages to pay off a debt

answer

garnishment

question

an individual who owes on an account and moves, leaving no forwarding address

answer

skip

question

NSF

answer

insufficient funds

question

WCO

answer

will call office

question

PIF

answer

PAYMENT IN FULL

question

NLE

answer

NO LONGER EMPLOYED

question

T

answer

TELEPHONED

question

SK

answer

SKIP/SKIPPED

question

FN

answer

FINAL NOTICE

question

UE

answer

UNEMPLOYED

question

A STRAIGHT PETITION IN BANKRUPTCY OR ABSOLUTE BANKRUPTCY

answer

CHAPTER 7

question

A WAGE EARNER'S BANKRUPTCY

answer

CHAPTER 13

question

BONDING METHODS (3)

answer

POSITION SCHEDULE BOND, BLANKET POSITION BOND, PERSONAL BOND

question

A SYSTEM OF BILLING ACCOUNTS AT SPACED INTERVALS DURING THE MONTH ON THE BASIS OF A BREAKDOWN OF ACCTS BY ALPHABET, ACCT #, INSURANCE TYPE OR DOS

answer

CYCLE BILLING

question

REDUCTIONS OF THE NORMAL FEE BASED ON A SPECIFIC AMOUNT OF MONEY OR A PERCENTAGE OF THE CHARGE

answer

DISCOUNT

question

PHRASE TO REMIND A PT ABOUT A DELINQUENT ACCT

answer

DUN MESSAGE

question

INDIVIDUAL OWING MONEY

answer

DEBTOR

question

CLAIM ON THE PROPERTY OF ANOTHER AS SECURITY FOR A DEBT

answer

LIEN

question

INDIVIDUAL RECORD INDICATING CHARGES, PAYMENTS, ADJUSTMENTS AND BALANCES OWED FOR SERVICES RENDERED

answer

FINANCIAL ACCT RECORD (LEDGER)

question

DETAILED SUMMARY OF ALL TRANSACTIONS OF A CREDITOR'S ACCT

answer

ITEMIZED STATEMENT

question

PERSON TO WHOM MONEY IS OWED

answer

CREDITOR

question

LISTING OF ACCEPTED CHARGES OR ESTABLISHED ALLOWANCES FOR SPECIFIC MEDICAL PROCEDURES

answer

FEE SCHEDULE

question

LAW STATING THAT A PERSON HAS 60 DAYS TO COMPLAIN ABOUT AN ERROR FROM THE DATE THAT A STATEMENT IS MAILED

answer

FAIR CREDIT BILLING ACT

question

CONSUMER PROTECTION ACT THAT APPLIES TO ANYONE WHO CHARGES INTEREST OR AGREES ON PAYMENT OF A BILL IN MORE THAT FOUR INSTALLMENTS, EXCLUDING A DOWN PAYMENT

answer

TRUTH IN LENDING ACT

question

REGULATES COLLECTION PRACTICES OF 3RD PARTY DEBT COLLECTORS AND ATTYS WHO COLLECT DEBTS FOR OTHERS

answer

FAIR DEBT COLLECTION PRACTICES ACT

question

FEDERAL LAW PROHIBITING DISCRIMINATION IN ALL AREAS OF GRANTING CREDIT

answer

EQUAL CREDIT OPPORTUNITY ACT

question

REGULATES AGENCIES THAT ISSUE OR USE CREDIT REPORTS ON CONSUMERS

answer

FAIR CREDIT REPORTING ACT

question

SIGNING ANOTHER PERSON'S NAME ON A CHECK

answer

FORGERY

question

WHEN SENDING MONTHLY STATEMENTS WHAT SHOULD YOU WRITE ON THE ENVELOPE TO MAKE SURE THE POSTAL SERVICE CAN FORWARD

answer

FORWARDING SERVICE REQUESTED

question

A SERVICED OFFERED BY A NONPROFIT AGENCY ASSISTING IN PEOPLE PAYING OFF THEIR DEBTS

answer

CREDIT COUNCILING

question

INSURANCE PAYMENT CHECKS SHOULD BE STAMPED IN THE ENDORSEMENT AREA ON THE BACK \"FOR DEPOSIT ONLY\" WHICH IS KNOWN AS WHAT

answer

RESTRICTIVE ENDORSEMENT

question

INSURANCE COMPANIES AND THE FEDERAL GOVT DO NOT RECOMMEND WAIVING COPAYMENTS TO PATIENTS

answer

TRUE

question

REGULATION Z OF THE TRUTH IN LENDING CONSUMER CREDIT COST DISCLOSURE LAW APPLIES IF THE PT IS MAKING 3 PAYMENTS

answer

FALSE

question

MOST STATE COLLECTION LAWS ALLOW TELEPHONE CALLS WHEN

answer

BETWEEN 8 AM AND 9 PM

question

WHEN A PATIENT HAS DECLARED BANKRUPTCY IT IS PERMISSIBLE TO CONTINUE TO SEND MONTHLY STATEMENTS FOR A BALANCE DUE

answer

FALSE

question

A COLLECTION AGENCY MUST FOLLOW ALL THE LAWS STATED IN THE FAIR DEBT COLLECTION PRACTICES ACT

answer

TRUE

IHMO Chapters 9 + 10 review

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