Deck 7: Posting Payments and Creating Patient Statements

Question 1

Which of the following documents specifies the amount a provider bills for provided services?

A) managed care allowed charge
B) fee schedule
C) medicare allowed charge
D) payment schedule

Answer 1

fee schedule

Question 2

Which of the following documents specifies the amount the payer agrees to pay the provider for a service, based on a contracted rate of reimbursement?

A) managed care allowed charge
B) fee schedule
C) medicare allowed charge
D) payment schedule

Answer 2

payment schedule

Question 3

What is the maximum fee a Medicare participating provider can collect for services?

A) half of the charge
B) fee schedule
C) medicare allowed charge
D) payment schedule

Answer 3

medicare allowed charge

Question 4

What is the name of the payment schedule used by Medicare?

A) Medicare Usual Fee Schedule (MUFS)
B) Medicare Allowed Charge Schedule (MACS)
C) Medicare Physician Fee Schedule (MPFS)
D) Medicare Billed Charge Schedule (MBCS)

Question 5

How often is the Medicare Physician Fee Schedule (MPFS) updated?

A) monthly
B) quarterly
C) annually
D) every five years

Question 6

The amount the provider bills and the rate specified in the contract with the payer usually

A) are the same.
B) differ.
C) are negotiable.
D) change daily.

Question 7

A patient in an indemnity plan receives services valued at $240 according to a provider's usual fee and the allowed charge. How much does the patient pay for coinsurance if the insurer reimburses 80 percent of the allowed charges?

A) $0
B) $48
C) $192
D) $240

Question 8

A patient in an indemnity plan receives services valued at $430 according to a provider's usual fee, but the allowed charge is only $380. How much does the patient pay for coinsurance if the insurer reimburses 80 percent of the allowed charges?

A) $76
B) $86
C) $304
D) $344

Question 9

A patient in a managed care plan receives services valued at $615 according to a provider's usual fee, but the allowed charge is only $570. The patient has a required copayment of $20. Calculate the patient's payment for the services.

A) $20
B) $45
C) $114
D) $123

Question 10

A patient in a managed care plan receives services valued at $245 according to a provider's usual fee, but the allowed charge is only $220. The patient has a required copayment of $20. What is the adjustment that must be made by the practice?

A) $0
B) $20
C) $25
D) $44

Question 11

A patient in a managed care plan receives services valued at $135 according to a provider's usual fee, but the allowed charge is only $120. The patient has a required copayment of $20. What is the amount of the insurance payment?

A) $20
B) $80
C) $100
D) $120

Question 12

A Medicare patient receives services valued at $780 according to a provider's usual fee, but the MPFS allowed charge is only $700. Assuming the deductible has been met, what is the required patient payment?

A) $0
B) $20
C) $80
D) $140

Question 13

A Medicare patient receives services valued at $1,120 according to a provider's usual fee, but the MPFS allowed charge is only $1,035. Assuming the deductible has been met, how much is the amount of the practice's adjustment?

A) $0
B) $85
C) $207
D) $1,035

Question 14

If a provider who does not participate in the Medicare program accepts assignment for a Medicare patient, it will be paid ____________ percent less than providers who do participate.

A) 5
B) 20
C) 115
D) 15

Question 15

The Medicare limiting charge limits a nonparticipating provider to be able to charge what percent of the fee listed in the Medicare nonparticipating fee schedule?

A) 5 percent
B) 20 percent
C) 115 percent
D) None of these are correct. they are paid the same.

Question 16

A procedure on the Medicare nonparticipating fee schedule is priced at $320. How much can the nonparticipating provider charge for the procedure under the Medicare limiting charge?

A) $115
B) $272
C) $320
D) $368

Question 17

What is a payer's payment schedule based on?

A) a rate established in a contract with the provider
B) the provider's list of standard fees
C) the amount the provider bills the payer
D) All of these are correct.

Question 18

What is the amount a physician is reimbursed for a service based upon?

A) the provider's agreement with the third-party payer
B) the patient's insurance benefits
C) the practice management program
D) the provider's agreement with the third-party payer and the patient's insurance benefits

Question 19

Which of the following are included on a remittance advice?

A) dates of service
B) charges
C) patients
D) All of these are correct.

Question 20

An RA that is sent in ____________ is an electronic remittance advice (ERA).

A) paper format
B) electronic format
C) fax format
D) All of these are correct.

Question 21

Which of the following is the first step in processing a remittance advice?

A) compare the RA to the original insurance claim
B) identify the reasons for denials or payment reductions
C) bill the patient's secondary health care plan if appropriate
D) review the payment amount against the expected amount

Question 22

Which of the following is the last possible step in processing a remittance advice?

A) compare the RA to the original insurance claim
B) identify the reasons for denials or payment reductions
C) bill the patient's secondary health care plan if appropriate
D) review the payment amount against the expected amount

Question 23

What step in reviewing a remittance advice comes after comparing the RA to the original insurance claim?

A) compare the RA to the original insurance claim
B) identify the reasons for denials or payment reductions
C) bill the patient's secondary health care plan if appropriate
D) review the payment amount against the expected amount

Question 24

Which of the following statements is a reason why an insurance carrier might deny a claim?

A) A diagnosis may be coded incorrectly.
B) A procedure code may not be covered by a patient's plan.
C) A procedure may be coded incorrectly.
D) All of these are correct.

Question 25

What may a remittance advice contain?

A) multiple claims
B) claims for a number of different patients
C) a limit of one claim per patient
D) multiple claims and claims for a number of different patients

Question 26

Which of the following is the ERA that is mandated for use by HIPAA?

A) the ASC X12 835 Remittance Advice Transaction
B) the 835
C) the 837
D) the ASC X12 835 Remittance Advice Transaction and the 835

Question 27

What is the most common outcome when an insurance carrier pays a provider for a billed amount?

A) The insurance carrier does not fully pay the amount billed.
B) The insurance carrier pays the exact amount billed.
C) The insurance carrier pays more than the amount billed.
D) None of these are correct.

Question 28

What can happen if an error occurs during claims processing by the third-party payer?

A) a corrected remittance advice is generated
B) an appeal process may be started
C) both a corrected remittance advice is generated and an appeal process may be started
D) none of these is correct.

Question 29

Which of the following is the process in which providers who receive ERAs are able to have the payment information recorded directly to the patient's account?

A) autobilling
B) autopayment
C) autodenial
D) autoposting

Question 30

Which of the following is a likely result if a clerical error is made on a claim?

A) Reimbursement is denied.
B) Reimbursement is made at a reduced rate.
C) Payment is not received.
D) Reimbursement is denied or made at a reduced rate.

Question 31

Which of the following is a likely result if a claim is missing or lost in a payer's system?

A) Reimbursement is denied.
B) Reimbursement is made at a reduced rate.
C) Payment is not received.
D) Multiple procedures were not paid.

Question 32

Which of the following is a likely result if a payer either missed additional procedures or grouped them with the primary procedure?

A) Multiple procedures were not paid.
B) Reimbursement is made at a reduced rate.
C) Reimbursement is denied.
D) Payment is not received.

Question 33

Which of the following is a common claim error?

A) insufficient documentation provided to establish medical necessity
B) clerical errors
C) failure to follow preapproval guidelines
D) All of these are correct.

Question 34

The Enter Deposits/Payments option on the ____________ is used to enter payment information located on the remittance advice.

A) Lists menu
B) Activities menu
C) Reports menu
D) File menu

Question 35

The default setting is sorting payments by ____________, in the Sort By field of the Deposit List dialog box.

A) date and description
B) insurance carrier
C) amount
D) provider

Question 36

A user is able to indicate that a payer is ____________ in the Payor Type box in the Deposit dialog box.

A) an insurance carrier
B) a patient
C) a capitation plan
D) All of these are correct.

Question 37

What type of payment is made to physicians on a regular basis?

A) carrier
B) capitation
C) copayment
D) automatic

Question 38

The choices cash, credit card, check, and ____________ are all included in the Payment Method field in the Deposit dialog box.

A) electronic
B) bill later
C) pro bono
D) mail

Question 39

The Deposit dialog box appears when the ____________ button is clicked in the Deposit List dialog box.

A) Apply
B) Export
C) Edit
D) New

Question 40

Where are insurance payments entered in Medisoft?

A) the Select Payor dialog box
B) the Apply Payment/Adjustments to Charges dialog box
C) the Deposit List dialog box
D) the List Only Claims That Match dialog box

Question 41

A practice has agreed to a capitated plan with an insurance carrier under which it covers 20 patients and receives a $3,000-per-month reimbursement payment. What payment will the practice receive if it only treats 10 patients in a month?

A) $0
B) $1,500
C) $3,000
D) $6,000

Question 42

What dialog box appears when the New button is clicked in the Deposit List dialog box?

A) the Deposit dialog box
B) the Apply Payment/Adjustments to Charges dialog box
C) the Select Payor dialog box
D) the List Only Claims That Match dialog box

Question 43

You are entering payment details in the Deposit dialog box and need to enter some specific details about the payment. What box would be used to enter this information?

A) the Payment Method box
B) the Description/Bank No. box
C) the Deposit Code box
D) the Insurance box

Question 44

Where is the insurance carrier that is making the payment selected in the Deposit dialog box?

A) the Payment Method box
B) the Description/Bank No. box
C) the Deposit Code box
D) the Insurance box

Question 45

The appropriate codes for the ____________ are selected from the Payment Code, Adjustment Code, Withhold Code, Deductible Code, and Take Back Code boxes.

A) insurance carrier
B) provider
C) patient
D) physician

Question 46

What happens after a deposit entry is saved in the Deposit dialog box?

A) The Deposit List dialog box reappears blank.
B) The Deposit List dialog box reappears with the new deposit listed.
C) The Transaction Entry dialog box reappears blank.
D) The Transaction Entry dialog box reappears with the new deposit listed.

Question 47

What does the Export button in the Deposit List dialog box do?

A) applies payments to specific charge transactions
B) sends a command to print the deposit list
C) exports the data in either Quicken or QuickBooks program formats
D) None of these are correct.

Question 48

What happens when the Detail button is clicked in the Deposit List dialog box?

A) The Deposit Detail dialog box opens with more information about the selected deposit.
B) The payments are sorted by the selected data fields.
C) All the payments are displayed, regardless of the date entered.
D) All of these are correct.

Question 49

What button in the Deposit List dialog box is used to apply payments to specific charge transactions?

A) the Unapplied button
B) the Apply button
C) the Export button
D) the New button

Question 50

Information about ____________ is contained in the top section of the Apply Payment/Adjustments to Charges dialog box.

A) the patient
B) the payer
C) the amount of the payment that is unapplied
D) All of these are correct.

Question 51

Information about all ____________ charges for a patient is contained in the Apply Payment to Charges dialog box.

A) fully paid
B) covered
C) completed
D) unpaid

Question 52

In what section of the Apply Payments to Charges window are the payments entered and applied?

A) top
B) middle
C) lower
D) upper right-hand

Question 53

What section of the Apply Payment/Adjustments to Charges window contains several options that affect claims and statements?

A) top third
B) middle section
C) lower third
D) upper right-hand section

Question 54

Claims for any secondary or tertiary payer associated with a claim are created when the current insurance payment is saved, if the ____________ box is checked in the Apply Payments/Adjustments to Charges window.

A) Alert When Claims Are Done
B) Alert When Statements Are Done
C) Bill Remaining Insurances Now
D) Write Off Balance Now

Question 55

In the Apply Payment/Adjustments to Charges dialog box, $320.00 is entered in the Charge field and $295.00 is entered in the Allowed field. What amount will automatically be entered in the Adjustment field?

A) $0
B) $25.00
C) $295.00
D) $320.00

Question 56

In the Apply Payment/Adjustments to Charges dialog box, $160.00 is entered in the Charge field and $28.00 is entered in the Adjustment field. What amount must be displayed in the Allowed field?

A) $28.00
B) $132.00
C) $160.00
D) $188.00

Question 57

Only ____________ amounts are contained in the Take Back field in the Apply Payment/Adjustments to Charges dialog box.

A) positive
B) negative
C) even dollar
D) None of these is correct.

Question 58

Take backs should be applied ____________ most of the time.

A) to the patient's first charge
B) to the patient's next charge
C) to the same charge that had the overpayment
D) evenly between all the patient's charges

Question 59

What may be entered in the Rejection field in the Apply Payment/Adjustments to Charges dialog box?

A) the name of the physician who provided the services that have been rejected
B) the name of the insurance carrier who rejected the claim
C) the patient's reason for not paying
D) a rejection message from the RA

Question 60

What is the purpose of the Options . . . button in the Apply Payment/Adjustments to Charges dialog box?

A) It is used to change the default statement printing settings.
B) It is used to change the default settings for patient payment application codes.
C) It is used to change the program options for writing off balances.
D) All of these are correct.

Question 61

When will a patient statement be created if a check mark appears in the Print Statement Now box?

A) immediately when the box is checked
B) when the insurance payment is applied
C) when the current insurance payment is saved
D) when the Medisoft program is closed

Question 62

Where are capitation payments entered in Medisoft?

A) Open Report dialog box
B) Deposit List dialog box
C) Apply Payment/Adjustments to Charges dialog box
D) Transaction Entry dialog box

Question 63

A second deposit is entered with a ____________ in order to adjust the patient accounts of those covered by a capitated plan.

A) matching amount
B) negative amount
C) zero amount
D) capitation amount

Question 64

In what dialog box must patient accounts be adjusted to a zero balance?

A) the Open Report dialog box
B) the Deposit List dialog box
C) the Apply Payment/Adjustments to Charges dialog box
D) the Transaction Entry dialog box

Question 65

What should be selected in the Payor Type field in the Deposit dialog box when entering capitation payments?

A) capitation
B) insurance
C) the name of the insurance carrier
D) the name of the provider

Question 66

What will be displayed in the Payment column of the Deposit List window when a zero amount deposit is saved?

A) The amount of the payment
B) "EOB Only"
C) "Capitation"
D) "Insurance"

Question 67

You need to locate all the patients who are covered by a monthly capitation payment. How is this task performed in Medisoft?

A) using the Search feature in the Claim Management dialog box
B) using the Sort By feature in the Claim Management dialog box
C) using the Change Status button in the Claim Management dialog box
D) using the List Only . . . button in the Claim Management dialog box

Question 68

Which of the following explains how to make an adjustment to an account with an applied zero payment?

A) identify the amount in the Remainder column and enter that amount into the Adjustment column
B) identify the amount in the Adjustment column and enter that amount into the Remainder column
C) enter a zero amount in the Remainder column
D) enter a zero amount in the Adjustment column

Question 69

Which of the following statements is true about the procedure for adjusting patient accounts?

A) Adjustments should be made one time for each capitation payment.
B) Adjustments should be made two times for each capitation payment.
C) Adjustments should be made for each patient who has transactions during the time period covered by the capitation payment.
D) None of these are correct.

Question 70

Clicking the ____________ button instructs Medisoft to generate statements after all selections are complete in the Create Statements dialog box.

A) Create
B) Print
C) Display
D) Produce

Question 71

Which of the following statuses can be applied to a patient statement in Medisoft?

A) Ready to Send
B) Done
C) Sent
D) All of these are correct.

Question 72

Which statements list only those charges that are not paid in full after all insurance carrier payments have been received?

A) patient statements
B) remainder statements
C) standard statements
D) billing statements

Question 73

Which statements show all charges regardless of whether the insurance has paid on the transactions?

A) patient statements
B) remainder statements
C) standard statements
D) billing statements

Question 74

What type of statement would a practice use to look at a full, comprehensive list of transactions?

A) patient statements
B) remainder statements
C) standard statements
D) billing statements

Question 75

What type of statement would a practice use to locate charges that still require further payment?

A) Patient statements
B) Remainder statements
C) Standard statements
D) Billing statements

Question 76

What type of statement would a practice use to attempt to collect on an overdue balance from a patient?

A) patient statements
B) remainder statements
C) standard statements
D) billing statements

Question 77

Which of the following is the reason that guarantors rather than patients are listed in the Statement Management dialog box?

A) The guarantors' names must match the chart numbers.
B) Practices prefer to mail multiple statements.
C) Statements are created only for those financially responsible for accounts.
D) All of these are correct.

Question 78

A statement needs to be sent to a child who was brought to the practice by her mother but has insurance coverage under her father's plan. Who is the appropriate person to whom a patient statement should be sent?

A) the insurance carrier
B) the child's father
C) the child's mother
D) the child

Question 79

What phrase in the Status column of the Statement Management dialog box is used to indicate that the transaction has been billed but not fully paid?

A) Ready to Send
B) Sent
C) Done
D) Completed

Question 80

What phrase in the Status column of the Statement Management dialog box is used to indicate that the transaction has not been billed?

A) Ready to Send
B) Sent
C) Done
D) Completed