Question 1

What is the name of a transaction that explains payment decisions to the provider?

Accepted Answer

A)  electronic health record 
B)  electronic convention form 
C)  electronic consultation form 
D)  electronic remittance advice 
A)  electronic health record 
B)  electronic convention form 
C)  electronic consultation form 
D)  electronic remittance advice

Question 2

A (n) _________ is made when the practice has overcharged a patient for a service and the patient has a credit balance.

Accepted Answer

A)  refund 
B)  rebate 
C)  reduction 
D)  discount 
A)  refund 
B)  rebate 
C)  reduction 
D)  discount

Question 3

The feature in some software packages that automatically posts the payment data in the RA to the correct account is called ____.

Accepted Answer

A)  autoposting 
B)  autocorrect 
C)  autoplacement 
D)  autoposition 
A)  autoposting 
B)  autocorrect 
C)  autoplacement 
D)  autoposition

Question 4

A check drawn on an account that does not have adequate funds to cover the check is called ______.

Accepted Answer

A)  refund check 
B)  discount check 
C)  NSF check 
D)  disregard check 
A)  refund check 
B)  discount check 
C)  NSF check 
D)  disregard check

Question 5

_____ are laws regulating collection practices.

Accepted Answer

A)  Debt Practice Guidelines Act 
B)  Fair Debt Collection Practices Act 
C)  Debt Collection Guidelines Act 
D)  Fair Recording Collection Act 
A)  Debt Practice Guidelines Act 
B)  Fair Debt Collection Practices Act 
C)  Debt Collection Guidelines Act 
D)  Fair Recording Collection Act

Question 6

If a claim has been denied or payment reduced, what is filed with the payer for reconsideration?

Accepted Answer

A)  plea 
B)  appeal 
C)  application 
D)  petition 
A)  plea 
B)  appeal 
C)  application 
D)  petition

Question 7

Downcoding may occur when the procedure does not link correctly to the _____.

Accepted Answer

A)  prognosis 
B)  physician 
C)  diagnosis 
D)  insurance 
A)  prognosis 
B)  physician 
C)  diagnosis 
D)  insurance

Question 8

The physician may decide to dismiss a patient who does not pay medical bills. If the patient is to be dismissed, this action should be _______.

Accepted Answer

A)  documented in a letter to the patient 
B)  documented in a letter to the insurance company 
C)  documented in a letter to the government 
D)  documented in a letter to the IRS 
A)  documented in a letter to the patient 
B)  documented in a letter to the insurance company 
C)  documented in a letter to the government 
D)  documented in a letter to the IRS

Question 9

Adjudication is made up of five steps designed to see how the benefits will be paid. Which of the following is not one of the steps?

Accepted Answer

A)  initial processing 
B)  manual review 
C)  determination 
D)  resolve 
A)  initial processing 
B)  manual review 
C)  determination 
D)  resolve

Question 10

After patient bills are sent, what process is used to follow up on late payments?

Accepted Answer

A)  transaction 
B)  adjustment 
C)  aging 
D)  collection 
A)  transaction 
B)  adjustment 
C)  aging 
D)  collection

Question 11

Regulations mandated under the Affordable Care Act (ACA) as of January 1, 2014, require a _______ to appear on both the EFT and its ERA, so the documents are easy to match up electronically.

Accepted Answer

A)  verification number 
B)  trace number 
C)  substantiation number 
D)  support number 
A)  verification number 
B)  trace number 
C)  substantiation number 
D)  support number

Question 12

After the practice has exhausted all of its collection efforts and a patient's balance is still unpaid, the account may be labeled as a (n) ______.

Accepted Answer

A)  absenteeism account 
B)  uncollectible account 
C)  malingering account 
D)  indolent account 
A)  absenteeism account 
B)  uncollectible account 
C)  malingering account 
D)  indolent account

Question 13

Most payers have an escalating structure of appeals: a complaint, an appeal, and a (n) ___.

Accepted Answer

A)  dispute 
B)  grievance 
C)  objection 
D)  protest 
A)  dispute 
B)  grievance 
C)  objection 
D)  protest

Question 14

An insurance aging report shows the ages of ______.

Accepted Answer

A)  patients 
B)  unpaid claims 
C)  insurance memberships 
D)  provider 
A)  patients 
B)  unpaid claims 
C)  insurance memberships 
D)  provider

Question 15

What is the report summarizing the business day's charges and payments called?

Accepted Answer

A)  day sheet 
B)  day statement 
C)  day report 
D)  day account 
A)  day sheet 
B)  day statement 
C)  day report 
D)  day account

Question 16

Improper or excessive payment resulting from billing errors is called ____.

Accepted Answer

A)  overpayment 
B)  imbursement 
C)  disbursement 
D)  compensation 
A)  overpayment 
B)  imbursement 
C)  disbursement 
D)  compensation

Question 17

An electronic deposit is called a (n) _______.

Accepted Answer

A)  walkout receipt 
B)  overpayment 
C)  explanation of benefits 
D)  electronic funds transfer 
A)  walkout receipt 
B)  overpayment 
C)  explanation of benefits 
D)  electronic funds transfer

Question 18

Claims may be downcoded because_____.

Accepted Answer

A)  the patient has not paid the copayment 
B)  service was performed out of state 
C)  the documentation fails to support the level of service claimed 
D)  insurance company has refused to pay the higher code 
A)  the patient has not paid the copayment 
B)  service was performed out of state 
C)  the documentation fails to support the level of service claimed 
D)  insurance company has refused to pay the higher code

Question 19

The insurance aging report is used to _______.

Accepted Answer

A)  monitor deductibles paid by patients 
B)  monitor overdue claims from payers 
C)  monitor copayments paid by patients 
D)  monitor insurance premiums paid by patients 
A)  monitor deductibles paid by patients 
B)  monitor overdue claims from payers 
C)  monitor copayments paid by patients 
D)  monitor insurance premiums paid by patients

Question 20

Electronic routing of funds between banks is called ______.

Accepted Answer

A)  electronic reserves transmission 
B)  electronic resources allocation 
C)  electronic sources apportionment 
D)  electronic funds transfer 
A)  electronic reserves transmission 
B)  electronic resources allocation 
C)  electronic sources apportionment 
D)  electronic funds transfer

What is the name of a transaction that explains payment decisions to the provider?

A (n) _________ is made when the practice has overcharged a patient for a service and the patient has a credit balance.

The feature in some software packages that automatically posts the payment data in the RA to the correct account is called ____.

A check drawn on an account that does not have adequate funds to cover the check is called ______.

_____ are laws regulating collection practices.

If a claim has been denied or payment reduced, what is filed with the payer for reconsideration?

Downcoding may occur when the procedure does not link correctly to the _____.

The physician may decide to dismiss a patient who does not pay medical bills. If the patient is to be dismissed, this action should be _______.

Adjudication is made up of five steps designed to see how the benefits will be paid. Which of the following is not one of the steps?

After patient bills are sent, what process is used to follow up on late payments?

Regulations mandated under the Affordable Care Act (ACA) as of January 1, 2014, require a _______ to appear on both the EFT and its ERA, so the documents are easy to match up electronically.

After the practice has exhausted all of its collection efforts and a patient's balance is still unpaid, the account may be labeled as a (n) ______.

Most payers have an escalating structure of appeals: a complaint, an appeal, and a (n) ___.

An insurance aging report shows the ages of ______.

What is the report summarizing the business day's charges and payments called?

Improper or excessive payment resulting from billing errors is called ____.

An electronic deposit is called a (n) _______.

Claims may be downcoded because_____.

The insurance aging report is used to _______.

Electronic routing of funds between banks is called ______.

From Patient to Payment Understanding Medical Insurance

Electronic Health Records, HIPAA, and Hitech: Sharing and Protectin

Patient Encounters and Billing Information

Diagnostic Coding

Procedural Coding

Payment Methods and Checkout Procedures

Health Care Claim Preparation and Transmission

Private Payers/Blue Cross and Blue Shield

Medicare

Medicaid

Tricare and Champva

Workers Compensation and Automobile/Disability Insurance

Hospital Insurance

Filters

Exam 13: Claim Processing, Payments, and Collections

What is the name of a transaction that explains payment decisions to the provider?

A (n) _________ is made when the practice has overcharged a patient for a service and the patient has a credit balance.

The feature in some software packages that automatically posts the payment data in the RA to the correct account is called ____.

A check drawn on an account that does not have adequate funds to cover the check is called ______.

_____ are laws regulating collection practices.

If a claim has been denied or payment reduced, what is filed with the payer for reconsideration?

Downcoding may occur when the procedure does not link correctly to the _____.

The physician may decide to dismiss a patient who does not pay medical bills. If the patient is to be dismissed, this action should be _______.

Adjudication is made up of five steps designed to see how the benefits will be paid. Which of the following is not one of the steps?

After patient bills are sent, what process is used to follow up on late payments?

Regulations mandated under the Affordable Care Act (ACA) as of January 1, 2014, require a _______ to appear on both the EFT and its ERA, so the documents are easy to match up electronically.

After the practice has exhausted all of its collection efforts and a patient's balance is still unpaid, the account may be labeled as a (n) ______.

Most payers have an escalating structure of appeals: a complaint, an appeal, and a (n) ___.

An insurance aging report shows the ages of ______.

What is the report summarizing the business day's charges and payments called?

Improper or excessive payment resulting from billing errors is called ____.

An electronic deposit is called a (n) _______.

Claims may be downcoded because_____.

The insurance aging report is used to _______.

Electronic routing of funds between banks is called ______.

From Patient to Payment Understanding Medical Insurance

Electronic Health Records, HIPAA, and Hitech: Sharing and Protectin

Patient Encounters and Billing Information

Diagnostic Coding

Procedural Coding

Payment Methods and Checkout Procedures

Health Care Claim Preparation and Transmission

Private Payers/Blue Cross and Blue Shield

Medicare

Medicaid

Tricare and Champva

Workers Compensation and Automobile/Disability Insurance

Hospital Insurance

Filters