question

The business assistant has the responsibility of maintaining complete, accurate, and up-to-date financial records in the following areas:

answer

• Billing and collection procedures • Financial planning • Declaring money earned to federal and state agencies

question

All financial agreements should be recorded on the account ___________

answer

ledger

question

_________________ is the means or process of recording, classifying, and summarizing financial transactions.

answer

Accounting

question

___________________ is the recording of the accounting process.

answer

Bookkeeping

question

What are the two types of bookkeeping systems used in a dental practice?

answer

Accounts Receivable Accounts Payable

question

What is the benefit of bonding insurance?

answer

This insurance will cover a loss, and the employee can be prosecuted under the law for any such theft.

question

Pegboard accounting, also known as a _____-________ ___________, is a manual bookkeeping system in which all records are completed with a single entry.

answer

one-write system

question

A charge slip, also referred to as a ___________ ______ or _____________, is used to transmit financial information from the treatment area to the business office.

answer

routing slip superbill

question

The _________ ______ contains information about the patient, such as name, account number and previous balance, current charges, and payment

answer

charge slip

question

What should be provided with a walk-out statement?

answer

A paid postage reply envelope, allowing the patient to mail the outstanding payment within a specific time period

question

Accepted fee

answer

The dollar amount that the contracting dentist has agreed to accept as payment in full from the insurance and the patient. This amount is shown on the notice that accompanies payment of a claim.

question

Annual maximum

answer

The total dollar amount that an insurance plan will pay for dental care incurred by an individual patient or family (under a family plan) in a specified benefit period, typically a calendar year.

question

Balance billing

answer

When a dentist bills the patient for an amount above fee and the enrollee's coinsurance, the dentist is balance billing and violating his/her contract with the insurance company

question

Basic services/basic benefits

answer

A category of dental services in an open network dental benefits contract that usually includes restorations (fillings), oral surgery (extractions), endodontics (root canals), periodontal treatment (root planing), and sealants. (This may vary by contract.) Typically, the same coinsurance percentage applies to all services grouped as basic services.

question

Benefits

answer

The amounts that the insurance pays for dental services covered under a patient's contract.

question

Capitation

answer

Compensation paid to general dentists in a closed network dental benefit plan (such as a DHMO) for providing covered services to enrollees assigned to their office.

question

Claim/claim form

answer

A standard form that provides an itemized statement submitted by an enrollee or a dentist requesting payment of benefits for dental services provided.

question

Closed network plan

answer

A type of dental plan where enrollees must visit a preselected or assigned network dentist in order to receive benefits.

question

Coinsurance

answer

The enrollee's share, expressed as a fixed percentage, of the contract allowance. For example, a benefit that is paid at 80% by the plan creates a 20% coinsurance obligation for the enrollee. Coinsurance applies after the enrollee meets a required deductible.

question

Contract benefit level

answer

The percentage of the maximum contract allowance that the insurance company pays after the deductible has been satisfied.

question

Contracted dentist

answer

A dentist who has a contract with the insurance company to participate in a network.

question

Contracted fee

answer

The fee for each single procedure that a contracted dentist has agreed to accept as payment in full for covered services provided to an enrollee.

question

Coordination of benefits (COB)

answer

A process that carriers use to determine the order of payment and amount each carrier will pay when a person receives dental services that are covered by more than one benefit plan (dual coverage). COB ensures that no more than 100% of the charges for services are paid when an enrollee has coverage under two or more benefits plans—for example, a child who is covered by both parents' plans.

question

Copayment

answer

A fixed dollar amount that an enrollee under certain dental plans (such as a DHMO-type plan) is required to pay at the time the service is rendered

question

Deductible

answer

A dollar amount that each enrollee (or, cumulatively, a family for family coverage) must pay for certain covered services before insurance begins paying benefits.

question

Diagnostic and preventive services

answer

A category of dental services in an open network dental benefits contract that usually includes oral evaluations, routine cleanings, x-rays, and fluoride treatments.

question

Dual choice

answer

A program that allows enrollees to select one of two or more dental plans. (Also may be referred to as "dual option.")

question

Dual coverage

answer

When dental treatment for an enrollee is covered by more than one dental benefits plan, such as when dental services are provided to a child who is covered by both parents' benefit plans.

question

Effective date

answer

The date a dental benefits contract begins; may also be the date that benefits begin for a plan enrollee.

question

Eligible enrollee

answer

An enrollee who has met the eligibility requirements under the insurance plan.

question

Eligibility

answer

The circumstances or conditions that define who and when a person may qualify to enroll in a plan and/or a specific category of covered services. These circumstances or conditions may include length of employment, job status, length of time an enrollee has been covered under the plan, dependency, child and student age limits, etc.

question

Fee-for-service

answer

Compensation paid to dentists based on an amount per service. A fee-for-service plan generally permits enrollees to freely select a network or noncontracted dentist to provide the service.

question

Health maintenance organization HMO

answer

An entity that is authorized to issue a benefit plan in which enrollees receive all or most treatment through a preselected or preassigned dental office. The dentist receives a monthly capitation payment for each patient who selects or is assigned to that office, no matter how many services that patient receives.

question

In-network/Out-of-network

answer

Services provided in a plan either by a contracted or noncontracted dentist. In-network dentists have agreed to participate in a plan and to provide treatment according to certain administrative guidelines and to accept their contracted fees as payment in full.

question

Lifetime maximum

answer

The cumulative dollar amount that a plan will pay for dental care incurred by an individual enrollee or family (under a family plan) for the life of the enrollee or the plan. Lifetime maximums usually apply to specific services such as orthodontic treatment.

question

Limitations and exclusions

answer

Dental plans typically do not cover every dental procedure. Each plan contains a list of conditions or circumstances that limit or exclude services from coverage. Limitations may be related to time or frequency (the number of procedures permitted during a stated period)—for example, no more than two cleanings in 12 months or one cleaning every 6 months.

question

Network

answer

A panel of dentists that contractually agree to provide treatment according to administrative guidelines for a certain plan, including limits to the fees they will accept as payment in full.

question

Open access

answer

A plan feature that allows enrollees to visit the dentists of their choice (freedom of choice). Also sometimes used to describe an enrollee's ability to seek treatment from a specialist without first obtaining a referral from his/her primary care dentist.

question

Open enrollment

answer

A period (usually a 2-week or 1-month period during the year) when qualified individuals (eligible employees) can enroll in or change their choice of coverage in group benefits plans.

question

Open network plan

answer

A type of dental plan where enrollees can visit any licensed dentist and can change dentists at any time without contacting the benefits carrier.

question

Out-of-pocket costs

answer

Any amount the enrollee is responsible for paying, such as coinsurance or copayments, deductibles, and costs above the annual maximum.

question

Patient's share

answer

The portion of a dentist's fee that an enrollee must pay for covered services, including coinsurance or copayment, any remaining deductible, any amount over plan maximums and/or any services the plan does not cover.

question

Preauthorization

answer

A requirement that recommended treatment must first be approved by the plan before the treatment is rendered in order for the plan to pay benefits for those services.

question

Preferred provider organization (PPO) plan

answer

A reduced fee-for-service plan that allows enrollees to visit any dentist, but encourages them to visit PPO network dentists to minimize out-of-pocket expenses. Enrollees usually pay less when visiting a PPO dentist.

question

Prepaid plan

answer

A term used to describe a benefits plan in which a carrier prepays network dentists a capitated amount for each patient enrolled in (assigned to) his/her office.

question

Pretreatment estimate

answer

The insurance company's written estimate of benefits available as of a specific date, given to an enrollee or treating dentist in advance of proposed treatment.

question

Primary enrollee

answer

An individual (commonly, an employee or member of an association) who meets the eligibility requirements for enrollment in a dental plan. Family members of a primary enrollee are called dependents.

question

Provider

answer

Any licensed dentist who performs dental health services for an enrollee. This includes general dentists and dental specialists.

question

Submitted fee

answer

The amount that the dentist bills and is entered on a claim as the charge for a specific procedure.

question

Table program

answer

A dental plan where benefits are based on a specific table or schedule of allowances or fees.

question

Usual fee

answer

The amount commonly charged for a particular service by a dentist.

question

Waiting period

answer

A stated period of time that a person must be enrolled in a plan before being eligible for benefits or for a specific category of benefits.

MDA Chapter 63 – Financial Management in the Dental Office – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards