Payment Methods and Checkout Procedures – Flashcards
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If a patient makes a payment at the time of service, a medical billing program is used print an____.
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walkout receipt
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Whether a physician participates in a plan or not is decided by_____.
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the physician
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Within a managed care organization the gatekeeper is another name for a_____.
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primary care physician
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Who makes referral for patients in an HMO?
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both the gatekeeper and the primary care physician
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Which of the following do not usually file claims for patients?
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non-participating physicians
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The first step in calculating RBRVS is to determine the______.
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procedure codes
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The abbreviation PPO stands for_____.
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preferred provider organization
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In some plans, a primary care physician (PCP) is assigned to______.
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each patient
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What should explain what is required of the patient financially when payment is due?
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financial policy
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Positive or negativce corrections to a patients account such as returned check fees are called_____.
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adjustments
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What does the abbreviation RVS stand for?
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relative value scale
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Out-of-pocket medical expenses are paid by the_____.
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patient
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Undder a point-of-service (POS) plan an HOM patient who does not to be limited to network providers might have to make_______.
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larger payments
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What document can the patient use to report the charges and payments to the insurance company?
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walkout receipt
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If a practice has not accepted assignment and collects payment from the patient at the time of service and then sends a claim to the plan on behalf of the patient what should the patient expect as the next course of action?
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receive a reimbursement check from the insurance company
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Which plan must meet a high deductible before the health plan can make a payment?
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consumer-driven health plan
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For which type of insurance plan would the medical assistant verify the patients deductible the coverage benefits and the coinsurance or other financial information?
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high deductible paln
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Which method does Medicare use to pay physicians in group practices?
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Resource-based relative value scale (RBRVS)
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What percentage of the allowed charge does Medicare Part B Original Plan cover after the patient meets their annual deductible?
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80%
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What percentage of the allowed charges is the patient responsible for through the Original Medicare plan after the patient meets their annual deductible?
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20%
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Which of the following is not a typical time-of-service payment?
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registration fees
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What is not a part of the real-time claims adjudication (RTCA).
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receive real-time payment
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After checkout, what is a next step in the billing cycle?
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send claim for insurance payments
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In order, what are the next steps in the billing cycle after the patient checks out?
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file claim, insurance payment, and patient billed for what they owe
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Which of the following is not taken into account when determining resource-based fee structures?
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how many credentials the physician performing the procedure has
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What does Real Time Claims Adjudication not generate?
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"real-time" payment
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What is the goal of an effective patient checkout procedure?
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the patient understands financial responsibility
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Which is not part of the RBRVS fee?
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UCR
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Which should be paid at the time of servive?
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previous balances
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Which type of payment is made during checkout based on an estimade?
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partial payment
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A preauthorization form is typically used with which type of transactions?
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credit card
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Which of the following is not usually accepted form of payment?
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wire transfer
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What does it mean when a provider accepts assignment?
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to accept the allowed charge as full payment
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Under what conditions of HIPPA is it permissible to bill a patient a reasonable chrage?
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copies of medical records
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If patients have large bills that they must pay over time what can be set up for them?
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payment plan
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What is one way a practice can help patients determine what they may owe?
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swipe card reader
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Which health plan has a rule that prohibits physicians from obtaining any patient payment except a copayment until after the claim is paid?
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Medicare
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What might a contract between a health plan and provider entail?
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to prohibit balance billing
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Whaen are payments from the patient entered and the account updated?
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after the patients visit
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What does the Real-Time Claims Adjucation tool not provide?
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exact payment due
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In what situation is the patient offered a walkout receipt?
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the patient made a payment at the end of a visit
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What summarizes the services and charges for that day as well as any payment the hpatient made?
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walkout receipt
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If the practice accepts credit and debit cards what standards must be followed?
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PCI DSS
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All of the following procedures are completed at the end of a patients visit, except:
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insurance is verified
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What is the tool for calculating charges due at the time of service?
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real-time claims adjudications (RTCA)
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To estimate charges the patient will pay the medical assistant verifies:
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deductible amount
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What might a health plan require if the patient has more than one covered service in a single day?
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multiple copayments
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Which of these payment methods is the basis for Medicares fees?
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RBRVS
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Which answer correctly lists the main methods payers use to pay providers?
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allowed charges contracted fee schedule and capitation
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If a providers charge is higher than the allowed amount the providers reimbursement is based on____.
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the amount allowed
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If the providers charge is lower than the allowed amount the reimbursement is based on_____.
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the amount billed
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Under a contracted fee schedule, the allowed amount is______compared to the providers charge.
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the same
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The deductibles, coinsurance, and copayments patients pay are called their_______.
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out-of-pocket expenses
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If a nonparticipating providers usual fee is $600, the allowed amount is $300 and balance billing is permitted what amount is written off?
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$0
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An option in an HMO that allows patients to use non-HMO providers is called______.
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a point-of-service option
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If a participating providers usual charge is higher than the allowed amount and balance billing is not permitted what should the difference between the two charges become?
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a write off
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Before the payer begins to pay benefits what must a policyholder pay annually under a typical indemnity plan?
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deductible
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Under most managed care plans what must patients pay to the provider at the time of service?
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copayment
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Medical insurance plans require patients to pay for all services that are_____.
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both excluded and over-limit
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At what pount in the billing process might a physician practice decide to have a policy to collect patients payments?
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both claims processing and adjudication
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Collecting the difference between a providers usual fee and a payers lower allowed charge from the insured is called?
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balance billing
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What term describes a physician who does not participate in a particualr plan?
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Non-PAR
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The amount of a copayment is determined by_____.
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the insurance carrier/health plan
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If the participating providers charge is higher than the allowed amount which is the basis for reimbursement?
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allowed amount
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When is a capitated paymetn made to a provider?
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before services are given
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A capitation payment covers the services for a health plan member for_____.
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a specific period of time
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The abbreviation CDHP stands for_______.
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consumer-driven health plan
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What are patients who do not have insurance coverage called?
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self-pay
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Discounted fee-for-service arrangements are also known as_____.
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contracted fee schedules
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A list of charges for the procedures and services a physician performs is a___-.
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fee schedule
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The abbreviation HMO stands for______.
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health maintenance organization
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What must be met before benefits from a payer begin?
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deductible
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Which of the following is not a component of a network created by a PPO?
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patients
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A PPO plan will pay lower benefits if a patient sees a provider who is_____.
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out-of-network
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