Download HOS 140 Health Insurance and Reimbursement Study Set: Questions and Answers and more Exams Advanced Education in PDF only on Docsity!
HOS 140 Health Wi thIn suCorrarencect An andsw Reimers 2bu 025 rsem- 26 ent Study Set
When the medical assistant receives notice that the collection agency is going to beresponsible for the collection of the patient's $300 balance, how much would the medical assistant record in the adjustment column? No balance due $100 $250 $300None of the above - ANSWER>>$
endorsing a check is: - ANSWER>>signing a name and account number on the back The petty cash fund kept in the medical office should: -from patient cash payments ANSWER>>be kept separate
A monthly bank statement lists: -the last closing date ANSWER>>all transactions that have occurred since
Which of the following, along with the medical record is considered a legal document? -ANSWER>>The day sheet and ledger card
True or False? The medical office accounting cycle can be performed on either a fiscalyear or a calendar year. - ANSWER>>True
An encounter form is also referred to as a (n) ________. - ANSWER>>All of the above One reason for writing notes on the memo section of a check is: -reference later if questions arise concerning payment ANSWER>>for
Kathy Williams, RMA, is going to reorder supplies. The form she will use that lists the
supplies and their order numbers before ordering the supplies is called: -purchase order ANSWER>>A
After writing a check to a service company, the medical assistant should also write onthe check stub the day, check number, and: - ANSWER>>Payee
When using a computer accounts payable system, financial data should be recorded onthe computer's hard drive, on a floppy disk, and on: - ANSWER>>A hard copy
The bookkeeping system that is used by most medical practices is the: -ANSWER>>single entry system
Elizabeth Benton, RMA, is going to pay bills for her medical practice using a computersoftware program. Perform the first step listed below:. - ANSWER>>Open the check writing file Which of the following statements regarding check stubs is true? -the above ANSWER>>All of
Debbie Murphy, CMA, has just written check numbr 472 to Tech Electronics for a newbeeper for the office manager, Mary Jones. Which of the following would go in the memo section of the check and the check stub? -office manager ANSWER>>New beeper for Mary Jones,
Which of the following purchases would be a good candidate to use the petty cashaccount? - ANSWER>>Stamps
Which of the following is NOT a true statement about ledger cards? -cars should be shredded at the end of the year ANSWER>>ledger
Which of the following does the daysheet track? - ANSWER>>All of the above
True or false? Most medical facilities use the cash basis type of accounting -ANSWER>>True
True or false? Brackets around an amount Indicate the opposite of the columns usualmeaning - ANSWER>>True
True or false? Borrowing $5 from the petty cash account for lunch is acceptable as longas you pay it back - ANSWER>>False
True or false? Manuel bookkeeping is old fashioned and no longer worth learning in thisera of computerized systems - ANSWER>>False
True or false? The allowed amount for a service and any necessary adjustments areprovided on an insurance carriers EOB - ANSWER>>True
True or false? The allowed amount for a service an any necessary adjustments areprovided on an insurance carriers cash paid-out sections - ANSWER>>False
true or False It is a good practice to flag the patients account and even to demand cashonly for future payments if the patients check have ever been returned for no sufficient funds - ANSWER>>True true or False You must always sign your name to correct made to ledger cards, daysheets, petty cash records, etc - ANSWER>>True
Money market accounts are a combination of a ____________ account and an interestbearing checking account - ANSWER>>Savings
____________ checks are stamped and signed by the bank to verify that the amount of thecheck is being held in the account for payment - ANSWER>>Certified
__________ are the amounts the practice owes -payable ANSWER>>Liabilities or accounts
_________ is a review of accounts - ANSWER>> A _________ is a successive 12 month period beginning with a specific date -ANSWER>>Accounting cycle
Listing financial transactions in a ledger is also referred to as _______ proofs -ANSWER>>Posting?
An entry to adjust an account is referred to as a __________ - ANSWER>>Adjustment Two sides of an accounting equation must always be equal or in _______ -ANSWER>>Balance
Completed daysheets are filed __________ in a ledger with the most recent day sheet intop - ANSWER>>Chronologically
A photocopy of an individual ledger card is sent as a _______ - ANSWER>>Bill Ledger cards are filed _____________ in a ledger tray - ANSWER>>Alphabetically __________ are smaller versions of an encounter form and are designed to be used inconjunction with ledger cards - ANSWER>>Charge slips
To post chargers into a computer Database, you used a local or access _______ toindicate a certain procedure of service - ANSWER>>Code
Most fees collected by the medical practice should be collected within _____ days. -
During a patient's office visit, Steve Jones, CMA, informs a patient that his account isoverdue. This is: - ANSWER>>A common collection method
In addition to using a collection agency, a medical office can collect unpaid debt by: - ANSWER>>Using small claims court A Medicare fee schedule has three columns. They are - ANSWER>>Participating fee, nonparticipating fee, and limiting charge On which of the following grounds is it legal to deny a patient credit? - ANSWER>>None of the above Which of the following would be an indication that a practice's billing and collectionprocedures should be reviewed? - ANSWER>>More than 50% of fees are collected 30 days or more after billing. Which of the following statements is true regarding collecting a debt from a patient'sestate? - ANSWER>>All of the above
Mary Martinez, CMA, is telephoning Louise Jones, a patient, regarding a balance on herneedle biopsy bill. Mrs. Jones has a $500 balance that is 120 days in arrears. Which of the following messages is appropriate to leave on Mrs. Jones answering machine? -ANSWER>>Mrs. Jones, this is Mary Martinez. Please call me at 555-5555.
Which of the following is a type of adjustment that may be written off on a practice'sfederal taxes? - ANSWER>>Write off
Which of the following is NOT a common source of payment for most physician's offices?- ANSWER>>Trade
In addition to a copy of any insurance cards, what should the medical assistant request
from the patient for the chart? - ANSWER>>Drivers license Which of the following does the Fair Debt Collection Act NOT prohibit when trying tocollect a debt from a debtor? - ANSWER>>Fair treatment
Which of the following statements regarding collecting a debt via telephone is true? -ANSWER>>All of the above
Which of the following regarding performing a collection analysis is true? -ANSWER>>All of the above
Which of the following is a major credit reporting firm? A) Experian B) TransunionC) Equifax D) All of the above E) None of the above - ANSWER>>All of the above True or False? Barter is a form of payment not commonly accepted by most physicianoffices. - ANSWER>>True
True or False? Copays should be paid at the time of service. - ANSWER>>True True or False? Most collection problems in the medical office stem from patients givingincomplete information on the first visit. - ANSWER>>True
True or False? A good time to call about a past debt is before 8 a.m. - ANSWER>>False True or False? Credit cannot be denied based on age, gender, race, marital status,
- ANSWER>>False. ?? True or false? When a physician charges other health professionals a reduced rate, it iscalled a professional courtesy - ANSWER>>True
A(n) ________ is a cancellation of unpaid debt. - ANSWER>>Write off True or false? If a patient is on an installment plan, the patient receives a bill that liststhe amount due for that month, any third-party payments or adjustments, the total amount due, and the amount the patient owes. - ANSWER>>True A credit rating or credit __________ is assigned to consumers who have credit and canhelp you make better-informed decisions about granting credit. - ANSWER>>Score
Experts consider a collection percentage above _________ percent to be reasonable. -ANSWER>>80%
Changes in a posted account are called _______. - ANSWER>>Adjustments Managed care companies usually require that the patient pay a certain share of the bill,known as the patient _______. - ANSWER>>Copay
A collection __________ lets you identify the - ANSWER>>Analysis Credit cannot be denied because of age, sex, racial, marital status, religious, or nationalorigin, or source of __________. - ANSWER>>Income
true or false? Fee setting in the physician office is generally based on the UCR conceptand also considers the RBRVS. - ANSWER>>False
true or false? Federal regulations require that a sign listing the services and proceduresoffered in an office along with descriptions, procedure codes, and prices must be posted in the office. - ANSWER>>True A __________ charge is the amount a physician can charge a Medicare patien -ANSWER>>Limiting
An insurance plan that is self-insured may hire an agency to process and make thepayments. The agency would be: A) A health maintenance organization B) A peer-review organizationC) A third-party administrator D) A group members agency E) None of the above - ANSWER>>C) A third-party administrator The patient may be covered under more than one insurance company. If this is the case,the primary insurance is: A) The one that is billed first B) The company that is billed for the remainder of the charges when payment has beenreceived C) The only insurance company that is chosen to be billed D) The company that pays firstE) Paid by the employee - ANSWER>>A) The one that is billed first
Denial of an insurance claim may be because of:A) Appealing an insurance claim B) Confirmation that the patient is covered under the policy C) Complete patient informationD) Incorrect diagnostic and procedural coding
A) Carrier B) Child C) DependentD) Group member E) Participant - ANSWER>>C) Dependent A covered eligible patient is an individual who: A) Has obtained services from the physicianB) Does not have any benefits under the plan C) Has a listed family members enrolled in the health insurance D) Is covered under the effective dates of health insurance policyE) The above are incorrect - ANSWER>>D) Is covered under the effective dates of health insurance policy When submitting a claim for a patient that has Medicare and Medicaid, the claim willcrossover automatically from one plan to the other and referred to as: A) A dual claimB) A crossover claim C) A third-party administration claim D) A fee-for-service claimE) A coordination of benefits claim - ANSWER>>B) A crossover claim
Which of the following describes what is included under part? A) Part A B) Part BC) Parts A and B D) Part C E) None of the above - ANSWER>>B) Part B
The claim form that should be used to file a Medicare Health claim is the: A) Eligibility claim formB) Medicare claim form C) Crossover claim formD) CMS-1500 form E) CMS-1300 form - ANSWER>>D) CMS-1500 form A statement of unavailability is required for: A) Dependents of TRICARE recipients receiving hospital care B) Totally disabled veteransC) Care of a military patient treated at a civilian physician's office D) Military dependents seen in a military facility E) All of the above -physician's office ANSWER>>C) Care of a military patient treated at a civilian
Under the managed care plan to which Betsy Kennedy belongs, she must pay a share ofher medical expenses. The term for this is A) A deductible B) A copaymentC) Assignment of benefits D) CoinsuranceE) None of the above - ANSWER>>D) Coinsurance
A medical plan that pays the physician according to the number of his or her patientsenrolled in the plan is called: A) Fee-for-service plan B) Capitation
A) Family planning B) Skilled nursing facilities C) Diagnostic screenings for childrenD) Inpatient hospital care E) All of the above - ANSWER>>E) All of the above Categories into which inpatients are placed according to the similarity of theirdiagnoses, treatment, and length of hospital stay are known as: A) RBRVS B) DRGs C) EOBsD) ICD-9-CM codes E) None of the above - ANSWER>>B) DRGs true or false? The affordable care act (ACA) has a mandate that prohibits insurancecompanies from denying coverage to patients with preexisting conditions - ANSWER>>True The hospital coder utilizes what to select the appropriate DRG? A) RBRVSB) Codes specific to that facility C) EOBs D) ICD-9-CM codesE) None of the above - ANSWER>>D) ICD-9-CM codes
Dr. Martin asks you to exaggerate the extent of a patient's injury on an insurance claimform so that the doctor receives a larger reimbursement. Which of the following statements regarding the submission of insurance claims is true?A) Don't worry about it, the insurance company has plenty of money.
B) Insurance companies deny claims all of the time; this is your chance to get themback. C) You shouldn't report this physician because he's just working the system.D) All of the above. E) None of the above. - ANSWER>>E) None of the above. Reimbursement to physicians for Medicare services is based on a fee schedule that is inturn based on: A) RBRVS B) DRGs C) EOBsD) ICD-9-CM codes E) None of the above - ANSWER>>A) RBRVS True or False? Medicaid pays 100% for all outpatient treatment and services. -ANSWER>>True
True or False? Individuals who are registered in Social Security are automaticallyregistered in Medicare Part A. - ANSWER>>True
True or False? Primary insurance is the one that receives the claim form first. -ANSWER>>True
True or False? Blue Cross is a government-sponsored health care plan. -ANSWER>>False
True or False? Most managed care insurance programs require precertification andreferrals. - ANSWER>>True
True or False? The terms deductible and coinsurance are interchangeable. -
Paying each provider based on the number of members enrolled in the health plan iscalled ________. - ANSWER>>capitation
A patient has a diagnosis of depression prior to the effective date of his plan's coverageand will not be covered for services related to the diagnosis or treatment of depression for 12 months. The patient's depression is considered a __________. -ANSWER>>preexisting condition
A __________ is a type of health benefit program whose purpose is simply to contractwith providers and then lease this network of contracted providers to health care plans.
- ANSWER>>preferred provider organization (PPO) _________ benefits were developed to cover the expenses resulting from a work-relatedillness or injury. - ANSWER>>Workers' compensation
The rule followed generally by benefit plans and claims administrators for coordinatingthe benefits of dependent children covered by two plans is known as the "_______". - ANSWER>>birthday rule The government-sponsored health plan that pays for active-duty military personnel'smedical coverage is _____. - ANSWER>>TRICARE
DRGs are used to determine _________ for Medicare patients' inpatient services. -ANSWER>>reimbursement
With DRGs, a patient who has an unusually long stay or a complicated case isconsidered a(n) __________. - ANSWER>>outlier
True or false? EOB stands for explanation of benefits - ANSWER>>True Third-party insurance coverage may require __________ for a referral to a specialist. -
ANSWER>>precertification When a patient has more than one health care insurance policy, you bill first to theprimary company and the remainder of the charges to the __________ insurance. - ANSWER>>secondary
