SimChart 69 Post-Case Quiz
What is the function of a diagnosis pointer? - -Informs the insurance carrier
of the reason for the service provided
-Which statement or statements regarding the submission of insurance
claims is true? - -Electronic claims have fewer errors than paper claims.
-What is the primary reason for filing claims electronically versus using
paper claims? - -Turnaround time for payment is decreased
-When filing an insurance claim, which statement is accurate regarding the
patient's name? - -Should match the name listed on the insurance card
-Where are the procedure charges found in the medical office? - -Fee
schedule
-Which code is accurate when coding bronchitis, not specified as acute or
chronic? - -J40
-Which coding system is used in all health care settings? - -ICD-10-CM
-After the claim is submitted, the explanation of benefits states there is no
payment due to deductible not met. The patient is billed for the amount due
on the account and the patient calls to ask "Why did I get a bill; I have
insurance?" Which statement is best to use when explaining their
responsibility to the patient? - -"The explanation of benefits indicated you
have a deductible that has not been met."
-Suppose a patient has Medicare. The card says Part B. Which services will
the patient be responsible for, unless they have additional coverage? - -
Hospital stays
-If the same patient has an office visit and the charge is 120.00. The patient
has met the annual deductible. If Medicare allows $95.00 for this service and
the physician accepts assignment on Medicare, how much money will be
paid and posted in the patient account? - -$76.00
Rationale: Medicare Part B pays 80% of the allowed charged. $95.00
(allowed charge) is multiplied by 80% to get the amount of $76.00 payment.
-Using the above information, how much will the patient be billed for, after
Medicare's payment? - -$14.00
Rationale: The patient has met the deductible and the physician accepts
assignment. The patients' portion of the bill is 20% of the allowed charge.
$90.00 (allowed charge) is multiplied by 20% to get $19.00.
What is the function of a diagnosis pointer? - -Informs the insurance carrier
of the reason for the service provided
-Which statement or statements regarding the submission of insurance
claims is true? - -Electronic claims have fewer errors than paper claims.
-What is the primary reason for filing claims electronically versus using
paper claims? - -Turnaround time for payment is decreased
-When filing an insurance claim, which statement is accurate regarding the
patient's name? - -Should match the name listed on the insurance card
-Where are the procedure charges found in the medical office? - -Fee
schedule
-Which code is accurate when coding bronchitis, not specified as acute or
chronic? - -J40
-Which coding system is used in all health care settings? - -ICD-10-CM
-After the claim is submitted, the explanation of benefits states there is no
payment due to deductible not met. The patient is billed for the amount due
on the account and the patient calls to ask "Why did I get a bill; I have
insurance?" Which statement is best to use when explaining their
responsibility to the patient? - -"The explanation of benefits indicated you
have a deductible that has not been met."
-Suppose a patient has Medicare. The card says Part B. Which services will
the patient be responsible for, unless they have additional coverage? - -
Hospital stays
-If the same patient has an office visit and the charge is 120.00. The patient
has met the annual deductible. If Medicare allows $95.00 for this service and
the physician accepts assignment on Medicare, how much money will be
paid and posted in the patient account? - -$76.00
Rationale: Medicare Part B pays 80% of the allowed charged. $95.00
(allowed charge) is multiplied by 80% to get the amount of $76.00 payment.
-Using the above information, how much will the patient be billed for, after
Medicare's payment? - -$14.00
Rationale: The patient has met the deductible and the physician accepts
assignment. The patients' portion of the bill is 20% of the allowed charge.
$90.00 (allowed charge) is multiplied by 20% to get $19.00.
