question

What is set up in the practice management program when a patient's chief complaint is different than the one for a previous encounter?

answer

new case

question

What type of questions should be asked to physicians regarding billing and coding issues?

answer

essential only

question

What are the procedures that ensure billable services are recorded and reported for payment called?

answer

charge capture

question

A patient's insurance card usually shows:

answer

member identification number

question

Who typically documents the patient's vital signs?

answer

clinical medical assistant

question

What is the process when you can create a claim while the patient is being checked out and receive an immediate response from the payer?

answer

RTCA

question

A provider such as a facility who does not have face-to-face interaction with a patient is called a(n):

answer

indirect provider

question

Under what rule is a child's primary coverage under the father's plan when both parents have coverage?

answer

gender rule

question

What do payers issue when they approve a service?

answer

prior authorization number

question

If a retired patient with Medicare also has coverage under a working spouse's plan, the primary plan is:

answer

the spouse's plan

question

If a patient authorizes a provider to accept assignment, what can the provider now do on their behalf?

answer

file claims for the patient and receive payments directly from the payer

question

In recording a patient's name when sending it to a payer, what version of their name should be used?

answer

their name as it is shown on the insurance card

question

Under a coordination of benefits provision, what about the secondary payer is required to be reported?

answer

it is only required to be reported to the primary insurance if you have assignment of benefits

question

Identify the information that is not typically included on an encounter form.

answer

the patient's plan benefits

question

If a patient has coverage under two insurance plans, one under which the patient is the policyholder and one under which the patient is a dependent, the primary plan is:

answer

the patient's plan

question

A patient presents for an appointment, and you must locate the information about their health plan. Determine where this information should be located.

answer

patient's information form and insurance card

question

What Medicare form is used to show charges to patients for noncovered services?

answer

Advance Beneficiary Notice

question

Determine how a policyholder can authorize physicians to submit claims on their behalf and receive payments directly from payers.

answer

signing and dating an assignment of benefits statement

question

Patients will have the same chart number when

answer

none of these; chart numbers are unique

question

What should be verified when someone requests PHI for TPO purposes?

answer

the identity of the person and person's authority to access PHI

question

Pick the type of use of PHI that a practice would employ to submit claims on behalf of a patient.

answer

payment

question

If an employed patient has coverage under two insurance plans, one from a current employer and one from a previous employer, the primary plan is:

answer

the current employer's plan

question

Identify the person/entity that must authorize providers to release a patient's PHI for TPO purposes.

answer

none of these; they do not need authorization

question

If an employed patient has coverage under two insurance plans, one the employer's plan and the other a government plan, the primary plan is:

answer

the employer's plan

question

Identify the means by which practices can be sure that all visits have been entered in the practice management program.

answer

prenumbering

question

Which of the following information is gathered on the patient information form?

answer

the patient's personal and insurance information

question

The practice's rules for payment for medical services are found in their:

answer

financial policy

question

A new patient is defined as one who has NOT seen the provider within the last

answer

three years

question

Eligibility for Medicaid may change as quickly as:

answer

monthly

question

Which of the following is used to send necessary data to payers for a claim?

answer

X12 837

question

What provision explains how insurance policies will pay if more than one policy applies?

answer

coordination of benefits

question

Under Medicare, what must a provider receive before they are permitted to collect a deductible or any other payment?

answer

data on how the claim is going to be paid

question

Where is an assignment of benefits statement filed?

answer

patient medical records and patient billing records

question

What information must be documented in the patient's financial record when communicating with payers?

answer

the representative name, date and outcome

question

If a retired patient with Medicare also has coverage under a working spouse's plan, the primary plan is:

answer

the spouse's plan

question

If a patient has coverage under two insurance plans, the primary plan is the one that?

answer

has been in effect for the patient the longest

question

Select the most likely destination for a patient being sent by a referring physician.

answer

another physician

question

Identify the best time during which to begin collecting patient information.

answer

preregistration process

question

Identify a situation in which insurance is checked after an encounter.

answer

a medical emergency occurs

question

What Medicare form is used to show charges to patients for noncovered services?

answer

Advance Beneficiary Notice

question

Identify the means by which practices can be sure that all visits have been entered in the practice management program.

answer

prenumbering

question

Pick the type of use of PHI that a practice would employ to discuss a patient's case with another provider.

answer

treatment

question

Determine which of the following entities would be given a referral number.

answer

the referred physician

question

19.Patients who elect to pay a higher copayment, greater coinsurance, or both, are most likely visiting a:

answer

nonPAR

quiz 3 – Assignment Writing – Flashcards

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