Insurance Reimbursement: Final Exam
Review
explanation of benefits - ANSWER-After an insurance claim is processed by the
insurance carrier (paid, suspended, rejected, or denied), a document known as
_______ is sent to the patient and to the provider of professional medical services.
not obligated to carrier's deadline - ANSWER-If the provider has no contract with the
insurance carrier, the provider is _____.
Advance Beneficiary Notice - ANSWER-A patient should be asked to sign an ______ if
he or she has decided to undergo plastic surgery that is not related to a medical
condition.
overpayment - ANSWER-This is receipt of more than the contract rate from a managed
care plan for a patient who has received medical services.
accounts receivable - ANSWER-This is the unpaid balance due from patients for
professional services rendered.
patient registration form - ANSWER-This document provides demographic and
identifying data for each patient and assists in billing and collection.
courtesy adjustment - ANSWER-Another term for write off
garnishment - ANSWER-A court order attaching a debtor's property or wages to pay off
a debt.
forgery - ANSWER-Signing another person's name on a check to obtain money or pay
off a debt without permission is called
ask for photo ID, check the name on the card, get approval from credit card company -
ANSWER-When accepting a credit card as payment, the proper guidelines to follow are
(3):
vary - ANSWER-Time limits ____ with regard to insurance company's obligation to pay
benefits.
4-12 weeks, 7 days - ANSWER-It is reasonable to expect payment from insurance
company within _____ if claims are submitted on paper and within _____ when
transmitted electronically.
,state insurance commissioner - ANSWER-If a problem persists in receiving payment
from the insurance company, the _______ should be contacted.
dun messages - ANSWER-Phrases printed on statements to inform or remind a patient
about a delinquent account and to promote payment.
explanation of benefits - ANSWER-Document stating the status of the claim - whether is
it paid, adjusted, suspended, rejected,or denied.
allowed, disallowed - ANSWER-The EOB states the ____ and _____ amounts by the
third party payer.
no - ANSWER-Is there a standard format for EOBs.
allowed amount - ANSWER-The maximum dollar value the insurance company assigns
to each procedure and service on which payment is based.
financial accounting record - ANSWER-EOB should be posted to the
professional service descriptions, fees, payments, adjustments, running balance due -
ANSWER-The financial accounting record shows posting of _______, _____, ______,
______, and ______.
ledger - ANSWER-The financial accounting record is also known as
insurance claims register - ANSWER-Completed paper claims are logged into
tickler file - ANSWER-An alternative manual method used to track pending or
resubmitted insurance claims is a
tickler file - ANSWER-This type of file can be used to remind patients of upcoming or
missed appointments
contract time limits, traced - ANSWER-Delinquent claims remaining in the tickler file and
exceeding the ______ should be _____.
cash flow - ANSWER-The ongoing availability of actual cash.
financial accounting record - ANSWER-All discounts must be electronically posted to
the patient's
overhead expenses, financial difficulties - ANSWER-When claims aren't paid in a timely
manner, ______ cannot be met and practice will face _____.
, outsourcing - ANSWER-Using a billing service to manage billing for the practice is
called
hearings, compliance - ANSWER-The state insurance commissioner can hold ______
to determine if insurers, etc. are in _____ with the insurance laws of the state.
make payment - ANSWER-The state insurance commissioner does not have the
authority to order an insurance company to _____.
state insurance commissioner - ANSWER-These individuals have broad powers to
regulate the insurance companies within their state.
initial contact - ANSWER-Information about office fees and payment policies should be
provided during ______ with the new patient.
information pamphlet, brochure, confirmation letter - ANSWER-To inform a new patient
about office fees and payment policies, you should provide a(n) ______ or _____ and
______.
backlog of claims, insured, covered, copy of the claim, certified mail with return receipt,
fax the claim and ask for confirmation - ANSWER-In dealing with a lost claim, first check
to see if there is a ______. Then make sure the patient is ______ and _____. If the
claim is determined to be lost, submit _______ by _____ or _____
medical record - ANSWER-Written or graphic information about patient care is termed
_______
integrated record - ANSWER-__________ is written or dictated to record chronological
facts and observations about a patient's health.
fines and penalties, excluded from Medicare program - ANSWER-If a medical practice
is audited by Medicare officials and intentional miscoding is discovered, ________ may
be levied and providers may be _____.
section is in error, date, time, correct information, when, why - ANSWER-An electronic
record should be corrected by making a note that a _____ with the _____ and _____
and enter the _____ with a notation of _____ and ____ the physician changed the entry.
flag, amended, obsolete, addendum, separate document, chart note - ANSWER-A
method for correcting an electronic record is to ____ it as ______ or ______ and create
_______ either as a _____ or ______.
limited access - ANSWER-A method for correcting an electronic record is to move it to
_____ section of the record.
Review
explanation of benefits - ANSWER-After an insurance claim is processed by the
insurance carrier (paid, suspended, rejected, or denied), a document known as
_______ is sent to the patient and to the provider of professional medical services.
not obligated to carrier's deadline - ANSWER-If the provider has no contract with the
insurance carrier, the provider is _____.
Advance Beneficiary Notice - ANSWER-A patient should be asked to sign an ______ if
he or she has decided to undergo plastic surgery that is not related to a medical
condition.
overpayment - ANSWER-This is receipt of more than the contract rate from a managed
care plan for a patient who has received medical services.
accounts receivable - ANSWER-This is the unpaid balance due from patients for
professional services rendered.
patient registration form - ANSWER-This document provides demographic and
identifying data for each patient and assists in billing and collection.
courtesy adjustment - ANSWER-Another term for write off
garnishment - ANSWER-A court order attaching a debtor's property or wages to pay off
a debt.
forgery - ANSWER-Signing another person's name on a check to obtain money or pay
off a debt without permission is called
ask for photo ID, check the name on the card, get approval from credit card company -
ANSWER-When accepting a credit card as payment, the proper guidelines to follow are
(3):
vary - ANSWER-Time limits ____ with regard to insurance company's obligation to pay
benefits.
4-12 weeks, 7 days - ANSWER-It is reasonable to expect payment from insurance
company within _____ if claims are submitted on paper and within _____ when
transmitted electronically.
,state insurance commissioner - ANSWER-If a problem persists in receiving payment
from the insurance company, the _______ should be contacted.
dun messages - ANSWER-Phrases printed on statements to inform or remind a patient
about a delinquent account and to promote payment.
explanation of benefits - ANSWER-Document stating the status of the claim - whether is
it paid, adjusted, suspended, rejected,or denied.
allowed, disallowed - ANSWER-The EOB states the ____ and _____ amounts by the
third party payer.
no - ANSWER-Is there a standard format for EOBs.
allowed amount - ANSWER-The maximum dollar value the insurance company assigns
to each procedure and service on which payment is based.
financial accounting record - ANSWER-EOB should be posted to the
professional service descriptions, fees, payments, adjustments, running balance due -
ANSWER-The financial accounting record shows posting of _______, _____, ______,
______, and ______.
ledger - ANSWER-The financial accounting record is also known as
insurance claims register - ANSWER-Completed paper claims are logged into
tickler file - ANSWER-An alternative manual method used to track pending or
resubmitted insurance claims is a
tickler file - ANSWER-This type of file can be used to remind patients of upcoming or
missed appointments
contract time limits, traced - ANSWER-Delinquent claims remaining in the tickler file and
exceeding the ______ should be _____.
cash flow - ANSWER-The ongoing availability of actual cash.
financial accounting record - ANSWER-All discounts must be electronically posted to
the patient's
overhead expenses, financial difficulties - ANSWER-When claims aren't paid in a timely
manner, ______ cannot be met and practice will face _____.
, outsourcing - ANSWER-Using a billing service to manage billing for the practice is
called
hearings, compliance - ANSWER-The state insurance commissioner can hold ______
to determine if insurers, etc. are in _____ with the insurance laws of the state.
make payment - ANSWER-The state insurance commissioner does not have the
authority to order an insurance company to _____.
state insurance commissioner - ANSWER-These individuals have broad powers to
regulate the insurance companies within their state.
initial contact - ANSWER-Information about office fees and payment policies should be
provided during ______ with the new patient.
information pamphlet, brochure, confirmation letter - ANSWER-To inform a new patient
about office fees and payment policies, you should provide a(n) ______ or _____ and
______.
backlog of claims, insured, covered, copy of the claim, certified mail with return receipt,
fax the claim and ask for confirmation - ANSWER-In dealing with a lost claim, first check
to see if there is a ______. Then make sure the patient is ______ and _____. If the
claim is determined to be lost, submit _______ by _____ or _____
medical record - ANSWER-Written or graphic information about patient care is termed
_______
integrated record - ANSWER-__________ is written or dictated to record chronological
facts and observations about a patient's health.
fines and penalties, excluded from Medicare program - ANSWER-If a medical practice
is audited by Medicare officials and intentional miscoding is discovered, ________ may
be levied and providers may be _____.
section is in error, date, time, correct information, when, why - ANSWER-An electronic
record should be corrected by making a note that a _____ with the _____ and _____
and enter the _____ with a notation of _____ and ____ the physician changed the entry.
flag, amended, obsolete, addendum, separate document, chart note - ANSWER-A
method for correcting an electronic record is to ____ it as ______ or ______ and create
_______ either as a _____ or ______.
limited access - ANSWER-A method for correcting an electronic record is to move it to
_____ section of the record.
