Deck 9: Collections in the Medical Office

Question 1

What type of state laws mandate a time period within which clean claims must be paid and that call for financial penalties to be levied against late payers?

A) timely payment laws
B) prompt payment laws
C) state-mandated payment laws
D) fast payment laws

Answer 1

prompt payment laws

Question 2

Payers should be notified ____________ that payment has not been received if a clean claim is not paid within the allotted time frame, according to applicable prompt payment laws.

A) by phone
B) by fax
C) in writing
D) All of these are correct.

Answer 2

in writing

Question 3

Written explanations for all ____________ should be made by practices.

A) claim delays
B) claim denials
C) partial payments
D) All of these are correct.

Answer 3

All of these are correct.

Question 4

Which of the following actions should a practice first take if a clean claim is not paid within the allotted time frame?

A) notify the payer in writing that payment has not been received
B) submit an appeal to the appropriate state body
C) terminate the contract with the payer
D) request written explanation for claim delays

Question 5

You are working at a practice and realize that a claim has been denied from a payer. What should you request from the payer?

A) a partial payment
B) a written explanation of the claim denial
C) more information about the claim
D) All of these are correct.

Question 6

When a clearinghouse receives claims from a physician office, they are __________ against a series of edits.

A) scrubbed
B) cleaned
C) deleted
D) rejected

Question 7

Which of the following consequences may result from resubmitting rejected claims?

A) increased practice expenses
B) delays in payment
C) violation of the insurance contract
D) increased practice expenses and delays in payment

Question 8

How many states have enacted prompt payment laws to ensure that claims are paid in a timely manner?

A) only New York
B) three states
C) five states
D) most states

Question 9

Your practice has not received a satisfactory payment or explanation from a payer, and has not been able to reach the payer. What is the next step your practice should take?

A) request that the patient contact the payer
B) send a collection letter to the payer
C) notify the applicable state or federal regulatory agency
D) None of these are correct; no further action can be taken

Question 10

Under the New York Prompt Payment Law, to what is a physician entitled when a managed care organization or insurance company fails to make payment on a clean claim within 45 days of submission?

A) interest on the late payment
B) a monthly late fee
C) a yearly late fee
D) None of these are correct.

Question 11

Which of the following is a reason that a payer may use to deny a claim?

A) Patient care services are not covered under the payer-provider contract.
B) Patient care services were not medically necessary.
C) Patient care services were not properly documented.
D) All of these are correct.

Question 12

When further documentation is requested, it should be sent within a specific number of days, per timely _______ requirement.

A) manner
B) filing
C) response
D) submission

Question 13

What is often mandated by state prompt payment laws?

A) financial penalties to be levied against late payers
B) a time period within which clean claims must be paid
C) a time period within which providers must submit claims
D) financial penalties to be levied against late payers and a time period within which clean claims must be paid

Question 14

Claims rejected because they do not meet timely filing requirements are the responsibility of the ________.

A) payer
B) patient
C) provider
D) None of these are correct.

Question 15

How a practice handles ____________ should be indicated in its financial policy.

A) accepting cash, checks, money orders, and credit cards
B) collecting prepayment for services
C) setting up financial arrangements for unpaid balances
D) All of these are correct.

Question 16

You are reviewing a list of patients with past-due balances. Several patients have balances that are 45 days past due. What action should you take if your practice is following the suggested patient collection timeline?

A) bill patients
B) call patients
C) send letters
D) turn over to collections

Question 17

Usually, when a bill has not been paid within ____________ days after it was issued, an automatic reminder notice and a second statement are usually mailed.

A) 7
B) 30
C) 60
D) 90

Question 18

Which of the following is a common reason why patients do not pay their medical bills?

A) consumer-directed health plans with high out-of-pocket costs
B) lack of financial resources
C) lack of understanding that payment is their responsibility
D) All of these are correct.

Question 19

Which of the following signifies the beginning of the patient collection process?

A) a clear financial policy
B) effective communications with patients about their financial responsibilities
C) patient collection letters and phone calls
D) a clear financial policy and effective communications with patients about their financial responsibilities

Question 20

Collecting payments is ____________ when patients understand the charges and the practice's financial policy in advance.

A) not usually problematic
B) more difficult
C) not affected
D) None of these are correct.

Question 21

A new patient has arrived at the practice for an appointment. What document(s) should they be issued?

A) the practice's HIPAA privacy policies
B) patient registration material
C) the practice's financial policy
D) All of these are correct.

Question 22

What type of bills are given priority in the collections process?

A) smaller bills
B) large bills
C) individual bills
D) None of these are correct; no priority is given.

Question 23

What is the progression of collection letters as a bill becomes further and further past due?

A) They become more polite in tone and more pleading in approach.
B) They become more abusive in tone and more aggressive in approach.
C) They become more stringent in tone and more direct in approach.
D) None of these are correct; they remain consistent.

Question 24

What should a practice's financial policy tell patients?

A) how the practice handles collecting prepayment for services
B) how the practice handles collecting copayments and past-due balances
C) how the practice handles providing charity care or using a sliding scale for patients with low incomes
D) All of these are correct.

Question 25

Which of the following should not be included in a practice's financial policy?

A) how the practice handles making contracts with insurance carriers
B) how the practice handles accepting cash, checks, money orders, and credit
C) how the practice handles setting up financial arrangements for unpaid balances
D) how the practice handles collecting payment for services not covered by insurance

Question 26

According to a 2013 study by the Commonwealth Fund, ____ percent of Americans ages 19 to 64 had problems paying or were unable to pay medical bills in 2012.

A) 23
B) 30
C) 50
D) 70

Question 27

Which of the following forms of payment are usually accepted by practices?

A) credit cards
B) checks
C) money orders
D) All of these are correct.

Question 28

Collections from insurance carriers are considered _____ collections.

A) consumer
B) business
C) public
D) private

Question 29

Collections from patients are _____ collections.

A) consumer
B) business
C) public
D) private

Question 30

Which of the following regulate(s) debt collections?

A) the Telephone Consumer Protection Act of 1991
B) the Fair Debt Collection Practices Act of 1977
C) HIPAA
D) the Telephone Consumer Protection Act of 1991 and the Fair Debt Collection Practices Act of 1977

Question 31

Which of the following methods would be acceptable in attempting to collect debt from a patient over the phone?

A) calling the patient at midnight
B) using profane language toward the patient
C) calling the patient after 6:00 p.m.
D) deceiving the patient

Question 32

Name the agreement between a patient and a practice in which the patient agrees to make regular monthly payments over a specified period of time.

A) charity case
B) special deal
C) payment plan
D) financial deal

Question 33

A payment plan is subject to the ____________ if the practice adds finance charges and the payments are to be made in more than four installments.

A) Truth in Lending Act
B) HIPAA Security Rule
C) Telephone Consumer Protection Act of 1991
D) All of these are correct.

Question 34

Which of the following actions would be in compliance with collections guidelines?

A) calling a patient at 8:30 p.m.
B) calling a patient at 7:30 a.m.
C) threatening the patient
D) talking to a patient's friend about the patient's debt

Question 35

Which of the following actions would be in compliance with collections guidelines?

A) using profane language to collect a debt
B) only discussing the patient's debt with someone who is responsible for payment
C) using deception to collect a debt
D) calling a patient at 9:30 p.m.

Question 36

Which of the following actions would not be in compliance with collections guidelines?

A) calling a patient at 9:30 a.m.
B) talking about a patient's debt to a person who is responsible for payment, but not the patient
C) deceiving the patient to collect a debt
D) refraining from the use of threats

Question 37

Which of the following actions would not be in compliance with collections guidelines?

A) threatening the patient with consequences to collect a payment
B) calling the patient at 8:30 p.m.
C) collecting a debt without the use of deception
D) telling the patient you are responsible for debt collections at the practice

Question 38

The amount of finance charge applied to late accounts by a practice must comply with which of the following?

A) HITECH Act
B) Patient Payment Act
C) Fair Collections Act
D) Truth in Lending Act

Question 39

You need to set up a payment plan for a patient who owes a total of $840 and wants to pay off his balance in four months. Calculate his monthly payment, assuming there are no finance charges and no fees.

A) $84
B) $210
C) $240
D) $420

Question 40

You need to set up a payment plan for a patient who owes a total of $600 and wants to pay off her balance in five months. Calculate her monthly payment, assuming there are no fees or interest.

A) $50
B) $100
C) $120
D) $150

Question 41

Who must sign a payment plan agreement?

A) the practice manager
B) the patient
C) the insurance carrier
D) the practice manager and the patient

Question 42

What type of regulations applies if no finance charges are applied to unpaid balances under a payment plan agreement?

A) federal regulations
B) state regulations
C) federal and state regulations
D) No regulations apply.

Question 43

What must a practice do before it can add finance charges on late accounts?

A) cover the policies for adding finance charges on late accounts in the printed or displayed payment policy
B) have the patient and the practice manager sign the payment plan agreement
C) contact the patient's insurance carrier to verify that it is acceptable to add the finance charges
D) All of these are correct.

Question 44

Which of the following is an outside firm hired to collect on delinquent accounts?

A) law firm
B) collection agency
C) debt agency
D) collection firm

Question 45

On what basis are collection agencies often paid?

A) the practice's financial ability to pay
B) the satisfaction of the patients they contact
C) the amount of money they collect
D) All of these are correct.

Question 46

Which of the following does a statement provided by a collection agency show?

A) which patient accounts have paid
B) amounts of the payments
C) patient accounts it thinks are most likely to pay
D) which patient accounts have paid and amounts of the payments

Question 47

A practice sends $32,000 worth of patient account balances to a collection agency. If the collection agency collects 25 percent of this total and retains 30 percent of the amount it collects, calculate the total amount of money it will keep.

A) $2,400
B) $8,000
C) $9,600
D) $17,600

Question 48

A practice sends $12,000 worth of patient account balances to a collection agency. If the collection agency collects 40 percent of this total and retains 25 percent of the amount it collects, calculate the total amount of money the practice will receive.

A) $1,200
B) $3,000
C) $3,600
D) $4,800

Question 49

Collection Agency A retains 30 percent of the $6,000 it collects and Collection Agency B retains 10 percent of the $20,000 it collects. Which collection agency retains more money?

A) Collection Agency A
B) Collection Agency B
C) They both retain the same amount of money.
D) None of these are correct.

Question 50

A practice sends $10,000 worth of account balances to both Collection Agency A and Collection Agency B. Collection Agency A collects 20 percent of the balances and retains 50 percent of the amount it collects; Collection Agency B collects 10 percent of the balances and retains 25 percent of the amount it collects. Determine from which collection agency the practice will receive the most money.

A) Collection Agency A
B) Collection Agency B
C) The practice will receive the same amount of money from both collection agencies.
D) None of these are correct.

Question 51

A practice sends $16,000 worth of account balances to both Collection Agency A and Collection Agency B. Collection Agency A collects 25 percent of the balances and retains 20 percent of the amount it collects; Collection Agency B collects 40 percent of the balances and retains 50 percent of the amount it collects. Determine from which collection agency the practice will receive the most money.

A) Collection Agency A
B) Collection Agency B
C) The practice will receive the same amount of money from both collection agencies.
D) None of these are correct.

Question 52

Determine which of the following types of collection agencies a practice should select.

A) one that has a reputation for collecting the most amount of money
B) one that has a reputation for fair and ethical handling of collections
C) one that treats the patients the best but collects only a small amount of money
D) None of these are correct.

Question 53

What role does the medical insurance specialist have once a patient's account is referred to an agency for collection?

A) The medical insurance specialist sends statements.
B) The medical insurance specialist contacts the patients regarding the account.
C) The medical insurance specialist sends statements and contacts the patients regarding the account.
D) None; the medical insurance specialist's role ends.

Question 54

What must happen when a payment is received from a collection agency?

A) It must be posted to the patient's account.
B) The patient must be informed.
C) The patient must be contacted about the payment.
D) All of these are correct.

Question 55

The amount owed that is written off the practice's expected accounts receivable when collection efforts are discontinued is called ____.

A) a bad debt
B) an uncollectible account
C) a failed loan
D) a bad debt or an uncollectible amount

Question 56

What is a balance that has been removed from a patient's account?

A) write-off
B) deduction
C) credit
D) send off

Question 57

Which of the following explains why the collection process is sometimes ended?

A) The cost of continuing to pursue the debt is higher than the total amount owed.
B) All collection attempts have been exhausted.
C) The patient tells the practice he does not want to pay.
D) The cost of continuing to pursue the debt is higher than the total amount owed or all collection attempts have been exhausted.

Question 58

How can a practice write off any payments that Medicare or Medicaid beneficiaries are responsible for without the action being considered fraudulent?

A) by notifying Medicare or Medicaid of the action
B) by following a rigid set of steps to verify the patient's financial situation
C) by notifying Medicare or Medicaid of the action or by following a rigid set of steps to verify the patient's financial situation
D) None of these are correct; such an action is always considered fraudulent.

Question 59

Where is a write-off removed from?

A) a patient's account
B) the insurance contract
C) the collection agency
D) All of these are correct.

Question 60

Who creates the policies on how to handle bills that medical practices do not expect to collect?

A) medical practices
B) collection agencies
C) state and federal agencies
D) All of these are correct.

Question 61

Common features used for the purpose of collection efforts include

A) collection lists.
B) aging reports.
C) collection reports.
D) All of these are correct.

Question 62

As shown on the ____________, the collection process considers an analysis of the status of each account over time an important tool.

A) collection letter list
B) aging report
C) collection report
D) collection list

Question 63

A patient's account is considered current up to ____________ days in most aging reports.

A) 7
B) 15
C) 30
D) 60

Question 64

Which of the following accounts would be considered past due in most aging reports?

A) an account that has not been paid for 60 days
B) an account that has not been paid for 40 days
C) an account that has not been paid for 20 days
D) an account that has not been paid for 60 or 40 days

Question 65

Which of the following accounts would not be considered past due in most aging reports?

A) an account that has not been paid for 25 days
B) an account that has not been paid for 45 days
C) an account that has not been paid for 75 days
D) an account that has not been paid for 25 or 45 days

Question 66

What do medical practices frequently use to monitor collection activities?

A) collection phone calls
B) practice management software
C) collection letters
D) All of these are correct.

Question 67

What does an aging report show?

A) the amount of a practice's uncollectible accounts
B) the amount of a practice's write-offs
C) the status of each account over time
D) All of these are correct.

Question 68

Identify which of the following is not a common feature used for the purpose of collection efforts.

A) collection letters
B) summary reports
C) collection reports
D) aging reports

Question 69

What does an aging report show for each account?

A) the patient's name
B) the patient's chart number
C) the amount of unpaid charges in each of the aging categories
D) All of these are correct.

Question 70

The ____________, which tracks collections-related activities, is where overdue accounts are added in Medisoft.

A) collection list
B) aging report
C) tickler file
D) office notes

Question 71

Which of the following categories may appear in the Collection List window?

A) Responsible Party
B) Item
C) Type
D) All of these are correct.

Question 72

What button in the Collection List dialog box is pressed to create a new tickler item?

A) New
B) Tickler
C) Create
D) Display

Question 73

Activities that need to be completed as part of the collection process are tracked on the

A) tickler file.
B) collection list.
C) patient list.
D) collection reminder list.

Question 74

What is a reminder to follow up on an account that is entered on the collection list?

A) tickler
B) collection reminder
C) note
D) tickler or collection reminder

Question 75

The selections for the Collection List feature are located on the ____________ menu in Medisoft.

A) Activities
B) Tools
C) Reports
D) Edit

Question 76

What field in the Tickler tab specifies the action that will be taken on the overdue account?

A) Office Notes
B) Action Taken
C) Status
D) Action Required

Question 77

Open, Resolved, and ____________ are options in the Status field for ticklers.

A) Pending
B) Unresolved
C) Deleted
D) Active

Question 78

What is entered in the Type field of the Collection List dialog box to indicate the responsible party is the insurance carrier?

A) P
B) I
C) H
D) C

Question 79

In Medisoft's Collection List dialog box, what field indicates who is responsible for an item?

A) the Type field
B) the Patient field
C) the Item field
D) the Action field

Question 80

What are the names for the two tabs of the Tickler Item dialog box?

A) Action and Responsible Party
B) Tickler and Action
C) Tickler and Office Notes
D) Action and Office Notes