Deck 19: Electronic Medical Claims Processing

Question 1

The payments from EOBs and copays that are totaled on the calculator should equal:

A)positive amount on the Total Receipts line of the report.
B)negative amount on the Total Receipts line of the report.
C)total charges and adjustments from the EOBs.
D)total amount charged from the superbills.

Answer 1

negative amount on the Total Receipts line of the report.

Question 2

The negative amount of the Total Receipts line of the Patient Day Sheet report should equal:

A)charges posted for the day, as totaled from the encounter forms.
B)adjustments posted for the day, as totaled from EOBs.
C)payments posted for the day, as totaled from EOBs and copays.
D)payments and adjustments posted for the day, as totaled from the encounter forms.

Answer 2

payments posted for the day, as totaled from EOBs and copays.

Question 3

To review a list of outstanding patient accounts, the medical office specialist will refer to:

A)aging reports.
B)general ledgers.
C)encounter forms.
D)billed claims.

Answer 3

aging reports.

Question 4

After setting up the provider, if necessary, the first step in entering information into the medical practice management software is to:

A)enter the insurance carrier.
B)enter the charges.
C)enter the EOB.
D)enter new patients to the patient list.

Question 5

The medical office specialist should enter ICD-9 codes obtained from the:

A)patient history.
B)doctor's dictation.
C)encounter form (superbill).
D)progress notes.

Question 6

The report the medical office specialist should run at the end of the day to balance all transactions is the:

A)superbills report.
B)patient day sheet report.
C)general ledger.
D)balance report.

Question 7

To accurately post payments, the medical office specialist must be familiar with insurance carriers' and other payers':

A)financial health and industry rating.
B)contracts, procedures, and Explanation of Benefits (EOB) formats.
C)address, phone number, and e-mail address.
D)managers, administrators, and local representatives.

Question 8

If your MPM does not automatically save, how often should you manually save data?

A)At the end of the day
B)Once per hour
C)After each patient
D)After batching out and before creating claims

Question 9

In accounts receivable terminology, posting refers to:

A)subtracting payments made on an account.
B)making an adjustment on an account.
C)entering a financial transaction into a computer system.
D)making sure all accounts balance at the end of the day.

Question 10

If the amounts totaled from superbills and Explanation of Benefits forms (EOBs) do NOT match the report totals, the medical office specialist should:

A)review the report, superbills, and EOBs patient by patient to locate any errors.
B)submit the report to a supervisor with a memo stating the problem.
C)call the computer system repair person to check the program.
D)go home and address the problem the next day with a fresh outlook.

Question 11

The department or function in a medical office that is typically responsible for payment posting is:

A)receptionist.
B)accounts receivable.
C)clinical medical assistant.
D)medical records.

Question 12

The explanation of benefits (EOB) from an insurance company will include:

A)payments and adjustments from the carrier.
B)payments from the carrier and the patient.
C)the fee schedule on which payment was based.
D)the per-member-per-month fee.

Question 13

If the medical office specialist cannot find a CPT code in the medical practice management software, he or she should:

A)use the closest code.
B)ask the physician for a different code.
C)enter the new code into the database.
D)call the insurance carrier for assistance.

Question 14

After batching out the daily transaction(s), the medical office specialist should:

A)purge the system of all records.
B)print bills to send to patients.
C)create and submit insurance claims.
D)close the system and log off the computer.

Question 15

When the medical office specialist stops entering data for the day and generates and reviews reports to make sure that all accounts balance, the process is referred to as:

A)accounting.
B)batching out.
C)balancing out.
D)reporting.

Question 16

Payment posting includes posting all of the following EXCEPT:

A)payments to suppliers.
B)insurance payments.
C)patient payments.
D)contractual adjustments.

Question 17

The medical office specialist will post insurance payments and adjustments from:

A)superbills (encounter forms).
B)credit card receipts.
C)explanation of benefits (EOB) forms.
D)bank deposit slips.

Question 18

When the medical office specialist stops posting for the day, he or she should:

A)close the office and go home.
B)generate and print reports to review the next day.
C)generate and review reports and balance all transactions.
D)generate and review reports and inform the physician of any discrepancies.

Question 19

Imitating a situation or behavior as part of a learning process or training exercise is known as a:

A)simplification.
B)deception.
C)re-creation.
D)simulation.

Question 20

When posting charges to a patient account, the medical office specialist should obtain the CPT code(s) from the:

A)patient history.
B)doctor's dictation.
C)encounter form (superbill).
D)progress notes.

Question 21

The fee that the provider is charging for a service can be found on the:

A)registration form.
B)Explanation of Benefits (EOB).
C)encounter form.
D)Patient Day Sheet.

Question 22

Patient insurance information that must be entered into the medical practice management system can be found on the:

A)registration form.
B)Explanation of Benefits (EOB).
C)provider claim form.
D)Patient Day Sheet.

Question 23

A list of the supplies used during an office visit can be found on the:

A)registration form.
B)Explanation of Benefits (EOB).
C)encounter form.
D)Patient Day Sheet.

Question 24

A record of the patient's financial transactions for the encounter is called a(n):

A)EOB.
B)superbill.
C)walkout receipt.
D)batch report.

Question 25

A detailed accounting of charges that are the patient's responsibility can be found on the:

A)registration form.
B)Explanation of Benefits (EOB).
C)encounter form.
D)Patient Day Sheet.

Question 26

If a physician has referred the patient to the provider, the physician's name will be listed on the:

A)registration form.
B)Explanation of Benefits (EOB).
C)encounter form.
D)Patient Day Sheet.

Question 27

The subscriber on an account:

A)is also the guarantor.
B)is also the patient.
C)can be the guarantor and the patient.
D)can be the guarantor but not the patient.

Question 28

Any adjustments in amounts based on the insurance contract terms can be found on the:

A)registration form.
B)Explanation of Benefits (EOB).
C)encounter form.
D)claim form.

Question 29

Remarks by the insurance carrier explaining denials, pended claims, or adjustments in payment amounts can be found on the:

A)registration form.
B)Explanation of Benefits (EOB)
C)encounter form.
D)claim summary.

Question 30

A listing of billed services NOT covered by insurance can be found on the:

A)registration form.
B)Explanation of Benefits (EOB).
C)encounter form.
D)Patient Day Sheet.

Question 31

The patient's emergency contact information can be found on the:

A)registration form.
B)Explanation of Benefits (EOB) form.
C)provider claim form.
D)Patient Day Sheet.

Question 32

If a medical office specialist were to bill for a new patient office visit, the CPT code would be found on the:

A)registration form.
B)Explanation of Benefits (EOB).
C)encounter form.
D)ledger sheet.

Question 33

The patient on an account:

A)is always the guarantor.
B)is always the subscriber.
C)does not have to be the guarantor but must be the subscriber.
D)does not have to be the guarantor or the subscriber.

Question 34

A list of modifiers commonly used with procedure codes can be found on the:

A)registration form.
B)Explanation of Benefits (EOB).
C)encounter form.
D)Patient Day Sheet.

Question 35

Which document provides a record for the patient of the financial transactions associated with a particular encounter?

A)Patient information form
B)Walkout receipt
C)Explanation of Benefits (EOB)
D)Balance sheet

Question 36

Medical practice management software allows the user to:

A)submit claims electronically.
B)print paper claims.
C)check claim data onscreen.
D)all of the above.

Question 37

The provider's recommendation for when the next appointment should be scheduled can be found on the:

A)registration form.
B)Explanation of Benefits (EOB).
C)encounter form.
D)Patient Day Sheet.

Question 38

CPT codes and a brief descriptor of services provided can be found on the:

A)registration form.
B)encounter form.
C)Explanation of Benefits (EOB).
D)provider claim form.

Question 39

The guarantor on a patient account is the person who:

A)provided authorization for services.
B)referred the patient to the physician.
C)is responsible for the payment of bills.
D)is the patient's emergency contact.

Question 40

Patient demographic and insurance information can be found on the:

A)registration form.
B)Explanation of Benefits (EOB).
C)provider claim form.
D)Patient Day Sheet.

Question 41

When creating insurance claims using the medical practice management software, the medical office specialist should:

A)print out paper claims to check for accuracy.
B)print out a detailed report to check for accuracy.
C)perform a detailed audit to check for accuracy.
D)review the information onscreen to check for accuracy.

Question 42

The name of the physician rendering care to a patient on a specific day would be found on the:

A)registration form.
B)Patient Day Sheet.
C)ledger sheet.
D)encounter form.

Question 43

The medical office specialist will be responsible for entering all patient demographic information and posting all charges, payments, and adjustments.

Question 44

When a patient authorizes insurance payments to be made directly to the insurance company, the signature would appear on the:

A)registration form.
B)Explanation of Benefits (EOB).
C)encounter form.
D)preauthorization form.

Question 45

When entering a patient's insurance information into the system, it should be recorded exactly as it appears on the patient's insurance ID card.

Question 46

When batching out, patient payments such as copayments and deductibles should be added to EOB payments from insurance companies.

Question 47

When total charges, payments, and adjustments do NOT match the totals shown on the day sheet report, the medical office specialist must go through the report, encounter forms, and Explanation of Benefits forms (EOBs) patient by patient to find the discrepancy.

Question 48

Payments reflected on the Patient Day Sheet should equal the negative amount on the Total Receipts line of the report.

Question 49

The patient's marital status information would be found on the:

A)registration form.
B)Explanation of Benefits (EOB).
C)encounter form.
D)Patient Day Sheet.

Question 50

Patient information, payment method, and visit information would all be found on the:

A)registration form.
B)Explanation of Benefits (EOB).
C)encounter form.
D)ledger sheet.

Question 51

After patient demographic, insurance, and encounter-form information has been entered for an office visit, the next step is to create and submit the insurance claim.

Question 52

Medical practice management software typically contains a menu of CPT and ICD-9-CM codes.

Question 53

The patient's relationship to the subscriber can be:

A)self.
B)child.
C)spouse.
D)any of the above.

Question 54

The medical office specialist should enter ICD-9-CM code(s) directly from the patient history in the medical record.

Question 55

The patient's employment information would be found on the:

A)registration form.
B)Explanation of Benefits (EOB).
C)encounter form.
D)Patient Day Sheet.

Question 56

New patients should be entered into the provider database.

Question 57

If a physician refers the patient for lab work, he or she would indicate the order on the:

A)registration form.
B)encounter form.
C)Explanation of Benefits (EOB).
D)preauthorization form.

Question 58

Detailed information about the subscriber on the insurance plan that will be billed would be found on the:

A)registration form.
B)Explanation of Benefits (EOB).
C)encounter form.
D)ledger sheet.

Question 59

The medical office specialist should refer to the Explanation of Benefits (EOB) to make sure all transactions balance each day.

Question 60

The group number and policy number associated with a patient's primary and secondary insurance will be found on the:

A)registration form.
B)encounter form.
C)walkout receipt.
D)preauthorization form.

Question 61

The process of making sure that the totals of the day's charges, payments, and adjustments match those shown on the Patient Day Sheet report is known as __________ .

Question 62

The subscriber on an account is the person responsible for paying the bills.

Question 63

The default provider identification number is the federal __________ number.

Question 64

Payment posting is considered a(n) __________ function in a medical office or hospital.

Question 65

To post charges to an account, the medical office specialist refers to the __________ to obtain ICD-9 and CPT codes for the services provided.

Question 66

Charges posted to an account are assigned based on the ICD-9 code describing the patient's condition.

Question 67

Charges are posted to a patient account from information found on the Explanation of Benefits (EOB).

Question 68

If a patient was seen by the physician and will need a follow-up appointment, the physician will indicate this on the encounter form.

Question 69

If a patient becomes seriously ill while in the office and must be transported to the hospital by ambulance, his or her emergency contact will be listed on the encounter form.

Question 70

Details about a patient's deductible and coinsurance amounts can be found on the patient registration form.

Question 71

The patient is always the same as the subscriber on an account.

Question 72

Details about adjustments in payment amounts made by the insurance carrier are reported on the Explanation of Benefits (EOB).

Question 73

Patient demographic information such as date of birth and address can be found on the patient registration form.

Question 74

Patients will provide their demographic information on the patient __________ form.

Question 75

Both the patient and the __________ (the person responsible for paying the bills) must be added to the medical practice management software when entering a new account.

Question 76

A contractual adjustment on the EOB is the difference between the charged amount and the carrier's allowed amount for a service.

Question 77

Patient __________ information includes name, address, date of birth, and marital and employment status.

Question 78

The report run at the end of the day that reflects all posting activity for that day is called the __________ .

Question 79

The specific location or block on a computer screen into which data must be entered is called a(n) __________ .

Question 80

Three documents used to enter data in the simulation as well as in a medical office are __________ __________ and __________