AAPC CPB - Chapter 10 Review, 100% accurate |latest updated

AAPC CPB - Chapter 10 Review, 100% accurate |latest updated Which statement is TRUE regarding the Prompt Payment Act? a. Patients are required to pay patient balances within 30 days. b. Patient balances are dismissed if a statement is not sent to the patient within 30 days. c. Federal agencies are not required to respond to all clean claims within 30 days of receipt. d. Federal agencies are required to pay clean claims within 30 days of receipt. d. Federal agencies are required to pay clean claims within 30 days of receipt. When a provider wants to give a discount on services to a patient, which option is acceptable? a. The provider can waive the co-paymant at his discretion. b. The provider can accept insurance only payments and write-off all patient balances. c. The provider must discount the charge prior to billing the insurance carrier. d. The provider cannot discount the charge under any circumstance. c. The provider must discount the charge prior to billing the insurance carrier. What does a high number of days in A/R indicate for a medical practice? a. The practice is using their A/R for loan purposes. b. The practice has good policies in place, which results in good collections of outstanding balances. c. The practice potentially has a problem in the revenue cycle. d. The days in A/R do not indicate anything about the practice. c. The practice potentially has a problem in the revenue cycle. A provider removes a skin lesion in an ASC and receives a denial from the insurance carrier that states "Lower level of care could have been provided." What steps should the biller take? a. Write-off the charge. b. Check with the provider and write an appeal to the insurance carrier explaining why the service was provided in the ASC. c. Check with the provider and write an appeal to the insurance carrier explaining why the service was not an inpatient service. d. Submit the CMS-1500 claim form with a different place of service code. b. Check with the provider and write an appeal to the insurance carrier explaining why the service was provided in the ASC. When accepting debit cards in a medical practice, which act requires the office to disclose specific information before completing a transaction? a. Health Insurance Portability and Accountability Act (HIPAA) b. Electronic Funds Transfer Act c. Equal Credit Opportunity Act d. Fair Credit Billing Act b. Electronic Funds Transfer Act Which statement is TRUE regarding patient balances? a. Small balances for which processing costs exceed potential collections may be automatically written-off according to the financial policy of the practice. b. The financial policy of the practice cannot include information about write-offs for patient balances. c. Writing off any patient balance is considered waiving co-payments and puts the practice at risk for violating state and federal regulations. d. Best practices is to write-off any patient balance under $50.00. a. Small balances for which processing costs exceed potential collections may be automatically written-off according to the financial policy of the practice. Which statement is TRUE regarding denials? a. Denials should be reviewed to determine whether additional information is needed, if errors need to be corrected, or if the denial should be appealed. b. All denials should be written off in the practice management system. If appealed and paid, the balance can be reversed. c. Denials for lack of medical necessity cannot be appealed. d. Denials for not timely filing cannot be appealed. a. Denials should be reviewed to determine whether additional information is needed, if errors need to be corrected, or if the denial should be appealed. Review the following financial policy: Financial Policy: You are responsible for paying all co-payments at the time of service. Co-payments, co-insurance, deductibles and non-covered services cannot be waived by our office, as it is a requirement placed on you by your insurance carrier. Failure to pay your portion of services rendered will be reported to your insurance carrier and could result in termination of your insurance plan. Non-covered Services: The following services are considered "Non-Covered Services" by most insurance carriers. The fees listed below must be paid at the time of service. • Forms Completion: Disability Form, Insurance Form, Travel Form, Release from Work Form, Prior Authorization, and other forms are not required by most insurance plans or employers. If you require a physician to complete one of these forms, there will be a $25 charge in addition to your office visit charge. • Paper Medical Records: We will provide to you, upon written request, a paper copy of your medical record. We charge a base fee of $20.00 • Late Fees: Invoices not paid within 60 days will result in a $5 per month late fee. • Co-payment Collection Fee: If we must bill you for your co-payment, you may be required to pay a $20 Co-payment Collection fee. When must a co-payment be collected by the office for the patient to avoid a penalty? a. After receiving a statement. b. At the time of service. c. After the insurance is billed. d. Before the appointment is scheduled. b. At the time of service. What are some potential errors that can happen during patient registration? I. Invalid address II. Invalid ICD-10-CM code(s) III. Invalid CPT® code(s) IV. Invalid insurance information V. Invalid phone number a. I, II, III b. I, IV, V c. II, III d. I-V b. I, IV, V Which Act prohibits third-party debt collectors from calling debtors at odd hours? a. Truth in Lending Act b. Fair Credit Reporting Act c. Equal Credit Opportunity Act d. Fair Debt Collection Practices Act d. Fair Debt Collection Practices Act How often should the patient's insurance coverage be verified? a. every visit b. once a month c. once a year d. at the initial visit and when the insurance coverage changes a. every visit Review the following Accounts Receivable Management Policy: 1-Insurance claims will be created daily for manual and electronic filing. This should ensure that all insurance claims are submitted within two days of charge entry. 2-Guarantor statements will be created weekly to ensure timely initial billing of personal balances. Patients will receive one statement per month for personal balances. Each charge on which there is an unpaid personal balance will be billed a minimum of three times. 3-Insurance balances will be referred to internal follow-up staff for follow-up at 45 days post initial claim, and personal balances will be referred at the time the patient becomes responsible for payment. The collection services department becomes responsible for all balances as soon as the charge is entered. 4-Personal balances will be eligible for referral to an outside collection agency after three statements have been sent. Based on this policy, when does follow-up of insurance balances begin? a. Within two days of charge entry. b. After three claims have been sent. c. 45 days post initial claim. d. 60 days post initial claim. c. 45 days post initial claim. A claim has been denied as not medically necessary by Medicare. The biller has checked the patient's medical record and the patient's insurance policy. No ABN was signed. What is the next action the biller should take? I. Write-off the charge II. Check with the provider to appeal the claim III. Transfer the charge to the patient's account a. I b. II or III c. III d. I or II d. I or II Which option below is the better way to ask the patient about their current demographic information? a. Is your address 123 Highway 21? b. Are you still at 123 Highway 21? c. Has your address changed? d. What is your current address? d. What is your current address? What documents are needed for a successful appeal? a. Copy of the RA, copy of the medical record, copy of the original claim, and a letter detailing why the claim should be paid. b. The original RA, copy of the medical record, encounter form, and a statement from the patient. c. Copy of the RA, encounter form, medical record, and a letter detailing why the claim should be paid. d. Copy of the medical record, a letter detailing why the claim should be paid, and a statement from the patient. a. Copy of the RA, copy of the medical record, copy of the original claim, and a letter detailing why the claim should be paid. Which act protects information collected by the consumer reporting agencies? a. Truth in Lending Act b. Fair Credit Reporting Act c. Equal Credit Opportunity Act d. Fair Debt Collection Practices Act b. Fair Credit Reporting Act Which statement is TRUE about a patient's insurance? a. Verification of coverage should happen once per year. b. Insurance coverage can only change at the beginning of a year and it is good for the remainder of the year. c. Verification of coverage should happen at each visit. d. Once you have a patient's insurance information, it is up to the patient to let you know when it changes. c. Verification of coverage should happen at each visit. When a patient files Chapter 7 under the U.S. Bankruptcy Code, which statement is TRUE? a. The patient's debt is reorganized and paid at a discounted rate. b. The patient's debt is adjusted. c. Most medical debt is discharged, the provider will write-off amounts owed. d. The provider is required to refund the patient any balances paid. c. Most medical debt is discharged, the provider will write-off amounts owed. What steps should be taken when a medical office receives notice that a patient has filed bankruptcy? a. Obtain the case number, verify the case filing, verify the provider is listed as a creditor and stop all collection efforts for balances filed under the bankruptcy. b. Obtain the case number and write-off all patient and insurance balances on the patient's account. c. Stop all collection efforts and dismiss the patient from the practice. d. Dismiss the patient from the practice and send any outstanding balances to a collection agency. a. Obtain the case number, verify the case filing, verify the provider is listed as a creditor and stop all collection efforts for balances filed under the bankruptcy. Review the following financial policy: Collections Policy: Invoices not paid within 60 days begin our collection process. Invoices not paid within 120 days are subject to patient dismissal and submission to our Collection Agency and notification to your insurance plan. According to this policy, at what age is a balance owed by the patient considered a bad debt and sent to their collection agency? a. 30 days b. 60 days c. 120 days d. 365 days c. 120 days What is a prompt payment discount? a. A discount given to insurance carriers when payment is received in less than 30 days from the date of service. b. A discount given to patients when payment is received in less than 30 days from the date of service. c. A discount on premiums from the insurance carrier when the patient pays their co-payment at the time of service. d. A discount given to self-pay patients when they pay at the time of service. d. A discount given to self-pay patients when they pay at the time of service. What should be included in a financial policy? I. Explain that patient balances are due at the time services are provided. II. List insurance carriers the providers are contracted with. III. List insurance carriers the providers are not contracted with. IV. List the practice's policy when seeing patients who are out-of-network. V. List the patients on the Medicaid roster. a. I, III, V b. I, III, IV c. II, IV, V d. I, II, IV d. I, II, IV Once a credit balance for an insurance carrier has been identified, what action should the biller take? a. Research to determine if it is a true overpayment, then submit a refund to the insurance carrier for the overpayment. b. Research to determine if it is a true overpayment, then submit a refund to the patient for the overpayment. c. Post an adjustment to zero balance the account. d. Make a note in the practice management system and let the insurance carrier identify it. a. Research to determine if it is a true overpayment, then submit a refund to the insurance carrier for the overpayment.