Deck 3: Patient Encounters and Billing Information

Question 1

A (n) ______ is a patient that has not been seen by the provider within the past three years.

A) new patient
B) dependent
C) established patient
D) uninsured patient

Answer 1

A
A new patient (NP) is someone who has not received any services from the provider (or another provider of the same specialty or subspecialty who is a member of the same practice) within the past three years.

Question 2

A (n) _____ is patient who has been seen a provider within the past three years.

A) dependent
B) established patient
C) new patient
D) independent

Answer 2

B
An established patient (EP) is a patient who has seen a provider within the past three years. This patient has seen the provider (or another provider in the practice who has the same specialty/subspecialty) within the past three years. Established patients review and update the information that is on file about them.

Question 3

NP is the abbreviation for ____.

A) New Patient
B) No Procedure
C) New Insurance
D) No Dependent

Answer 3

A
A new patient (NP) is someone who has not received any services from the provider (or another provider of the same specialty or subspecialty who is a member of the same practice) within the past three years.

Question 4

EP is the abbreviation for _____.

A) Envisioned Patient
B) Established Patient
C) Expected Patient
D) Envisaged Patient

Question 5

Which of the following is not a type of information that is important to gather when a patient is new to the practice?

A) preregistration and scheduling information
B) medical history
C) assignment of benefits
D) license plate number

Question 6

A ____ is the physician who refers a patient to another physician.

A) specialist
B) secondary physician
C) referring physician
D) recommended physician

Question 7

In a managed care organization, a group of providers is called ______.

A) system
B) arrangement
C) organization
D) network

Question 8

A provider who agrees to provide medical services to a payer's policyholders according to a contract is called _____.

A) nonPAR
B) PAR
C) CPT
D) ICD

Question 9

PAR is the abbreviation for ____.

A) participating provider
B) participating insurance
C) partaking provider
D) partaking insurance

Question 10

A(n) ____ is a provider who does not join a particular health plan.

A) nonparticipating provider
B) uninsured provider
C) participating provider
D) non partaking provider

Question 11

nonPAR is the abbreviation for ___.

A) non partaking provider
B) nonparticipating provider
C) noncontributing provider
D) underwriting provider

Question 12

A provider that does not have a participation agreement with a plan is _____.

A) uninsured
B) unprofessional
C) unethical
D) out-of-network

Question 13

A form that includes a patient's personal, employment, and insurance company data is called ____.

A) patient information form
B) patient insurance card
C) medical practice id card
D) health services id card

Question 14

The policyholder or subscriber to a health plan or policy is called ____.

A) dependent
B) insured
C) underwriter
D) endorser

Question 15

Another term for the insured is ____.

A) dependent
B) endorser
C) cosigner
D) subscriber

Question 16

A (n) ______ is a person who is the insurance policyholder for a patient.

A) guarantor
B) insurance company
C) dependent
D) contingent

Question 17

_____ is a statement signed by the patient allowing benefits to be paid directly to the provider.

A) agreement of benefits
B) endorsement of benefits
C) assignment of benefits
D) consent of benefits

Question 18

On a patient insurance card, group identification number is ______.

A) used to identify the member's employer
B) used to identify the members group of providers
C) used to identify the dependents of the policy holder
D) used to identify the patient social security number

Question 19

On a patient insurance card, the plan codes are used for ____.

A) claims submissions when medical services are rendered out-of-state
B) claims submissions when medical services are rendered in the hospital
C) claims submissions for dependents
D) claims submissions when medical services are elective

Question 20

On a patient's insurance card, the number used to identify each plan member is the ___.

A) Organization Number
B) Association Number
C) Identification Number
D) Institute Number

Question 21

Under the HIPAA Privacy Rule, under what conditions can a provider release patients' PHI without prior authorization?

A) treatment, payment, and health care operations (TPO) purposes
B) requested by an office manager
C) requested by the patients spouse
D) research, compensation and examination purposes

Question 22

_______ states that the patient has read the privacy practices and understands how the provider intends to protect the patient's rights to privacy under HIPAA.

A) Acknowledgment of Receipt of Notice of Privacy Practices
B) Statement of Reading Form of Privacy Practices
C) Response of Reading Form of Privacy Practices
D) Declaration of Receipt of Privacy Practices

Question 23

In the practice management program (PMP) a unique number that identifies a patient is called ___.

A) identification number
B) social security number
C) chart number
D) patient number

Question 24

When an established patient shows up for his or her appointment, what is the most important question the front desk staff member should ask?

A) if any pertinent personal or insurance information has changed
B) if the patient would like to schedule a follow up visit
C) where would the patient wants the results sent
D) where would the patient want the referral sent

Question 25

Which of the following is not a step to establishing financial responsibility for an established patient?

A) Verify patients' eligibility for insurance benefits.
B) Determine preauthorization and referral requirements.
C) Determine the primary payer if more than one insurance plan is in effect
D) Determine if the patient has been out of the country in the past 90 days

Question 26

HIPAA X12N 270/271 is ____.

A) HIPAA Eligibility for Service Form
B) HIPAA Eligibility for a Health Plan electronic transaction form
C) HIPAA Eligibility for Health Care at Hospital form
D) HIPAA Eligibility For Health Care Out-of State Form

Question 27

To be paid for services, medical practices need to establish financial responsibility and the first step is ___.

A) verify what provider the patient will be seeing
B) verify that the patient has paid his or her premium
C) verify patients eligibility for benefits
D) verify the patients chart number

Question 28

When an eligibility benefits transaction (HIPAA 270) is sent the computer program assigns a unique number to the inquiry called ____.

A) chart number
B) tracking number
C) fax number
D) trace number

Question 29

____ is an identifying code assigned when preauthorization is required.

A) Prior chart number
B) Prior authorization number
C) Prior register number
D) Prior record number

Question 30

What is an authorization number given to the referred physician called?

A) insurance referral number
B) referral number
C) physician number
D) authorization number

Question 31

A(n) _____ is a document a patient signs to guarantee payment when a referral authorization is pending.

A) guarantee waiver
B) documentation waiver
C) endorsement waiver
D) referral waiver

Question 32

A(n) _____ ensures that the patient will pay for services received if a referral is not documented in the time specified.

A) referral waiver
B) guarantee waiver
C) documentation waiver
D) endorsement waiver

Question 33

Which health plan pays benefits first?

A) primary insurance
B) principal plans
C) secondary plan
D) chief plan

Question 34

An additional policy that provides benefits is called ___.

A) subordinate insurance
B) primary insurance
C) auxiliary insurance
D) secondary insurance

Question 35

Third insurance plan is called ____.

A) supplementary insurance
B) adjuvant insurance
C) tertiary insurance
D) subsidiary insurance

Question 36

A health plan that covers services not normally covered by a primary plan is called ___.

A) adjuvant insurance
B) tertiary insurance
C) supplementary insurance
D) subsidiary insurance

Question 37

_____ explains how an insurance policy will pay if more than one policy applies.

A) Coordination of benefits
B) Patient data form
C) Insurance rider form
D) Assignment form

Question 38

_____ guidelines that ensure that when a patient has more than one policy, maximum appropriate benefits are paid, but without duplication.

A) coordination of benefits
B) reimbursement of benefits
C) compensation of benefits
D) settlement of benefits

Question 39

Guideline that determines which parent has the primary insurance for a child is called ___.

A) birthday rule
B) compensation rule
C) repayment rule
D) reward rule

Question 40

When determining a patient's primary insurance and the patient has two group policies, which one is the primary?

A) the plan that has been in effect the longest period of time
B) the plan that has the lower co pay
C) the plan that has the highest premium
D) the plan that has lowest deductible

Question 41

When determining a patient's primary insurance and the patient has coverage under both a group and an individual plan, which one is the primary insurance?

A) individual plan
B) group plan
C) the plan that has the lower co pay
D) the plan the patient chooses

Question 42

When determining a patients' primary insurance and the patient is also covered as a dependent under another insurance policy, which is the primary insurance plan?

A) the parent's plan
B) the patient's plan
C) the plan that the patient chooses
D) the plan that the medical professional chooses

Question 43

A coordination of benefits rule that is used to determine which plan is primary when a child has primary insurance under both parents plans is called ____.

A) gender rule
B) the parents decide
C) the plan that has the lower copay
D) the plan that has the lowest deductible

Question 44

List of the diagnoses, procedures, and charges for a patient's visit is called a (n) ___.

A) patient form
B) patient statement
C) encounter form
D) patient report

Question 45

An encounter form is also called a(n) ____.

A) superbill
B) patient report
C) insurance record
D) data form

Question 46

Who completes the encounter form?

A) the patient
B) the insurance company
C) the provider
D) the front office staff

Question 47

All communications with payer representatives should be ___.

A) discussed with the physician
B) discussed with the office manager
C) documented
D) recorded

Question 48

After a medical assistant abstracts information about a patient's payer/plan, they contact the payer to verify three points. Which of the following is not one of these points?

A) Patients' general eligibility for benefits
B) The amount of the copayment or coinsurance required at the time of service.
C) if the planned encounter is for a covered service that is medically necessary under the payer's rules
D) the amount of the patient's premium

Question 49

What is recorded on the encounter form?

A) insurance contact information
B) physician information code
C) patients work information
D) diagnosis and procedures codes

Question 50

PIF is the abbreviation for _____.

A) prescription information form
B) patient information form
C) physician information form
D) pharmacy information form

Question 51

In the electronic transaction, HIPAA X12N 270/271 what does the 270 refer to?

A) the examination that is sent
B) the inquest that is sent
C) the analysis that is sent
D) the inquiry that is sent

Question 52

In the electronic transaction, HIPAA X12N 270/271 what does the 271 refer to?

A) the answer returned by the payer
B) the reaction returned by the payer
C) the resolution sent by the payer
D) the interpretation sent by the payer

Question 53

What should take place if an insured patient's policy does not cover a planned service?

A) medical assistant files a complaint with the insurance company
B) the patient applies for a new insurance policy
C) patients should be informed that the payer does not pay for the service and that they are responsible for the charges
D) the patient is referred to another medical facility

Question 54

When health plan responds to an eligibility inquiry, it includes information. Which of the following is not a piece of information that would be included?

A) trace number
B) benefit information
C) benefit units
D) SOAP number

Question 55

The Medicare program form that physicians must use to tell patients about uncovered services is called a (n) ____.

A) advance beneficiary notice
B) promissory note
C) benefactor notice
D) affiance note

Question 56

When an insured patient's policy does not cover a planned service, who is obligated to arrange for payment before services are given?

A) the government
B) the administration
C) the patient
D) the management

Question 57

When prior authorization is approved, where does the medical assistant enter the prior authorization number for use later on a health care claim?

A) PMP
B) HSS
C) CPT form
D) ICD form

Question 58

When a medical assistant at the specialist practice handles a referred patient, which of the following must the medical assistant do?

A) check the patient age
B) verify the patient chart number at the primary physician
C) check that the patient has a referral number
D) verify that the patient has a driver's license

Question 59

The COB guidelines ensure that when a patient that has more than one policy, maximum appropriate benefits are paid, but without ____________.

A) duplication
B) encounter form
C) cash benefits
D) synchronization form

Question 60

A retired patient who has Medicare is covered by a spouse's employer's plan and the spouse is still employed. Which plan is primary?

A) Medicare
B) Medicaid
C) spouse's plan
D) the plan with the lowest deductible

Question 61

If a dependent child's primary insurance does not provide for the complete reimbursement of a bill, who is responsible to pay the balance?

A) the balance is submitted to Medicare
B) the balance is submitted to Medicaid
C) the balance is submitted to a financial company by the parents
D) the balance is submitted to the other parent's plan

Question 62

When patients see a nonPAR, providers, they ____.

A) receive a discount
B) pay more for these out-of-network visits
C) pay a lower copayment
D) lose his or her insurance

Question 63

When the physician or medical assistant reviews information with the patient during the visit, where is this documented?

A) the process form
B) the insurance form
C) the practice form
D) the medical record

Question 64

In the PMP, a patient's visit for a new complaint is set up as a separate _____.

A) file
B) case
C) category
D) classification

Question 65

The practice management program (PMP) contains _____.

A) database of patients
B) database of resources
C) catalog of codes
D) catalog of research

Question 66

Payers want the name of the patient on a claim _____.

A) to skip middle initials
B) to include nicknames
C) to be the same as on the patients social security card
D) to be exactly as it is shown on the insurance card

Question 67

Only ______ is required to give patients an acknowledgment of receipt of a privacy notice to read and sign.

A) an indirect provider
B) a direct provider
C) the insurance company
D) the medical assistant

Question 68

If the plan is an HMO that requires a primary care provider (PCP), the general or family practice must verify which of the following?

A) the patient has paid their premium
B) the patient is assigned to the PCP as of the date of service
C) the insurance company has contacted the patient
D) the pharmacy has been selected

Question 69

If a patient who is required to have a referral document does not bring one, the medical assistant then asks the patient to sign ______.

A) referral waiver
B) disclaimer waiver
C) relinquishment waiver
D) agreement waiver