SOCIAL SCIENCE BUSINESS INSURANCE UPDATED ACTUAL QUESTIONS AND CORRECT ANSWERS

SOCIAL SCIENCE BUSINESS INSURANCE UPDATED
ACTUAL QUESTIONS AND CORRECT ANSWERS

Question:
What are collection agency fees based on?
Answer:
A percentage of dollars collected

Question:
Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule?
Answer:
Birthday

Question:
In what type of payment methodology is a lump sum or bundled payment negotiated between the payer
and some or all providers?
Answer:
Case rates

Question:
What customer service improvements might improve the patient accounts department?
Answer:
Holding staff accountable for customer service during performance reviews

Question:
What is an ABN (Advance Beneficiary Notice of Noncoverage) required to do?
Answer:
Inform a Medicare beneficiary that Medicare may not pay for the order or service

Question:
What type of account adjustment results from the patient's unwillingness to pay for a self-pay balance?
Answer:
Bad debt adjustment

Question:
What is the initial hospice benefit?
Answer:
Two 90-day periods and an unlimited number of subsequent periods

Question:
When does a hospital add ambulance charges to the Medicare inpatient claim?
Answer:
If the patient requires ambulance transportation to a skilled nursing facility

, Question:
How should a provider resolve a late-charge credit posted after an account is billed?
Answer:
Post a late-charge adjustment to the account

Question:
an increase in the dollars aged greater than 90 days from date of service indicate what about accounts
Answer:
They are not being processed in a timely manner

Question:
What is an advantage of a preregistration program?
Answer:
It reduces processing times at the time of service

Question:
What are the two statutory exclusions from hospice coverage?
Answer:
Medically unnecessary services and custodial care

Question:
What core financial activities are resolved within patient access?
Answer:
Scheduling, insurance verification, discharge processing, and payment of point-of-service receipts

Question:
What statement applies to the scheduled outpatient?
Answer:
The services do not involve an overnight stay

Question:
How is a mis-posted contractual allowance resolved?
Answer:
Comparing the contract reimbursement rates with the contract on the admittance advice to identify the
correct amount

Question:
What type of patient status is used to evaluate the patient's need for inpatient care?
Answer:
Observation

Question:
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the beneficiary has
received what?