Question 1

When the level of service is reduced by the claims examiner, it is known as ____.

Accepted Answer

A)  downcoding 
B)  adjusting 
C)  rejecting 
D)  denying 
A)  downcoding 
B)  adjusting 
C)  rejecting 
D)  denying A

Question 2

Typically, which patients should receive patient statements?

Accepted Answer

A)  all patients who have been to appointments within the last month 
B)  patients with balances due on their accounts after insurance payments have been received 
C)  all patients who have been to appointments within the last week 
D)  patients with balances due on their accounts before insurance payments have been received 
A)  all patients who have been to appointments within the last month 
B)  patients with balances due on their accounts after insurance payments have been received 
C)  all patients who have been to appointments within the last week 
D)  patients with balances due on their accounts before insurance payments have been received B

Question 3

Account deemed uncollectible is called ______.

Accepted Answer

A)  tax debt 
B)  bad debt 
C)  skiving debt 
D)  truanting debt 
A)  tax debt 
B)  bad debt 
C)  skiving debt 
D)  truanting debt B

Question 4

A patient ledger is a collection of what aspect of a patient's account?

Accepted Answer

A)  financial activity 
B)  medications 
C)  diagnosis 
D)  appointment dates 
A)  financial activity 
B)  medications 
C)  diagnosis 
D)  appointment dates

Question 5

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 6

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 7

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 8

What is the first step in answering patients' inquiries about claims?

Accepted Answer

A)  to talk with the office manager 
B)  to find out exactly what the problem is 
C)  to call the insurance company 
D)  to discuss it with the physician 
A)  to talk with the office manager 
B)  to find out exactly what the problem is 
C)  to call the insurance company 
D)  to discuss it with the physician

Question 9

_______ is a report grouping unpaid patients' bills by the length of time they remain due.

Accepted Answer

A)  patient aging report 
B)  patient mature report 
C)  patient established report 
D)  patient recognized report 
A)  patient aging report 
B)  patient mature report 
C)  patient established report 
D)  patient recognized report

Question 10

EOB is the abbreviation for ______.

Accepted Answer

A)  enlightenment of benefits 
B)  explanation of benefits 
C)  elucidation of benefits 
D)  evidence of benefits 
A)  enlightenment of benefits 
B)  explanation of benefits 
C)  elucidation of benefits 
D)  evidence of benefits

Question 11

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 12

Payer's decision about the benefits due for a claim is called ____.

Accepted Answer

A)  resolve 
B)  decide 
C)  regulate 
D)  determination 
A)  resolve 
B)  decide 
C)  regulate 
D)  determination

Question 13

If the practice applies finance charges or late fees, or if payments are scheduled for more than four installments, the payment plan is governed by ______.

Accepted Answer

A)  Notice of Office Policies Law 
B)  Notice of Privacy Law 
C)  Truth in Providing Act 
D)  Truth in Lending Act 
A)  Notice of Office Policies Law 
B)  Notice of Privacy Law 
C)  Truth in Providing Act 
D)  Truth in Lending Act

Question 14

Collection activities should achieve a suitable balance between maintaining patient satisfaction and _______.

Accepted Answer

A)  code compliance 
B)  insurance equilibrium 
C)  generating cash flow 
D)  physician satisfaction 
A)  code compliance 
B)  insurance equilibrium 
C)  generating cash flow 
D)  physician satisfaction

Question 15

Appeals are sent by patients or providers to payers to _______.

Accepted Answer

A)  request a review of a rejected or downcoded bill. 
B)  complain about a provider 
C)  negotiation payment 
D)  reach a compromise 
A)  request a review of a rejected or downcoded bill. 
B)  complain about a provider 
C)  negotiation payment 
D)  reach a compromise

Question 16

A (n) ______ explains the adjustment on the insured's account.

Accepted Answer

A)  alteration code 
B)  modification code 
C)  adjustment code 
D)  amendment code 
A)  alteration code 
B)  modification code 
C)  adjustment code 
D)  amendment code

Question 17

The comparison of two numbers is called ____.

Accepted Answer

A)  resolution 
B)  assessment 
C)  reconciliation 
D)  evaluation 
A)  resolution 
B)  assessment 
C)  reconciliation 
D)  evaluation

Question 18

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 19

What document shows which patient's payments are due or overdue?

Accepted Answer

A)  patient aging report 
B)  walkout receipt 
C)  electronic funds transfer 
D)  insurance aging report 
A)  patient aging report 
B)  walkout receipt 
C)  electronic funds transfer 
D)  insurance aging report

Question 20

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

When the level of service is reduced by the claims examiner, it is known as ____.

Typically, which patients should receive patient statements?

Account deemed uncollectible is called ______.

A patient ledger is a collection of what aspect of a patient's account?

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

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

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 _______.

What is the first step in answering patients' inquiries about claims?

_______ is a report grouping unpaid patients' bills by the length of time they remain due.

EOB is the abbreviation for ______.

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

Payer's decision about the benefits due for a claim is called ____.

If the practice applies finance charges or late fees, or if payments are scheduled for more than four installments, the payment plan is governed by ______.

Collection activities should achieve a suitable balance between maintaining patient satisfaction and _______.

Appeals are sent by patients or providers to payers to _______.

A (n) ______ explains the adjustment on the insured's account.

The comparison of two numbers is called ____.

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

What document shows which patient's payments are due or overdue?

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

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 Payersblue Cross and Blue Shield

Medicare

Medicaid

Tricare and Champva

Workers Compensation and Automobiledisability Insurance

Hospital Insurance

Filters

Exam 13: Claim Processing, Payments, and Collections

When the level of service is reduced by the claims examiner, it is known as ____.

Typically, which patients should receive patient statements?

Account deemed uncollectible is called ______.

A patient ledger is a collection of what aspect of a patient's account?

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

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

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 _______.

What is the first step in answering patients' inquiries about claims?

_______ is a report grouping unpaid patients' bills by the length of time they remain due.

EOB is the abbreviation for ______.

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

Payer's decision about the benefits due for a claim is called ____.

If the practice applies finance charges or late fees, or if payments are scheduled for more than four installments, the payment plan is governed by ______.

Collection activities should achieve a suitable balance between maintaining patient satisfaction and _______.

Appeals are sent by patients or providers to payers to _______.

A (n) ______ explains the adjustment on the insured's account.

The comparison of two numbers is called ____.

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

What document shows which patient's payments are due or overdue?

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

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 Payersblue Cross and Blue Shield

Medicare

Medicaid

Tricare and Champva

Workers Compensation and Automobiledisability Insurance

Hospital Insurance

Filters