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45 Cards in this Set
- Front
- Back
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When does can encounter begin? |
When the patient calls to make an appointment. |
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What do patients mostly look for? |
-Office location -Size -Layout |
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What type of information should physicians and medical assistants reveal with patients? |
They should only reveal information that relates to their patients. |
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In the next 30 years, what is going to happen to the population of patients ages 65 and older? |
The number of future geriatric patients will double. |
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Can you freely give a third party access to a patient's release of information? |
No, it is prohibited unless a consent is given. |
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What is assignment of benefits? |
Block 12 on the CMS-1500, it means that payments will be directly made to a provider.
[Doctors can bill on the patient's behalf.] |
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What is patient information form? |
Demographics. |
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What is a daily journal? |
A chronological record of patient transactions. |
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What is a peg board system? |
Method of accounting. |
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When using a computerized billing software, what should you always do? |
Always back-up files. |
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What is a billing cycle? |
Sending out statements periodically. |
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What should the biller do if a patient has not filled out the insurance information portion of their form? |
The biller should ask the patient why they have not filled in any insurance information. |
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What is the Truth in Lending Act? |
The promise to make payments of more than 4 installments. |
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What are problem debitors? |
-Chronically slow -Forgetful -Fraudulent |
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What is the Fair Debt Collection Act? |
Prevent abusive collections. |
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What is the organization that arranges payments to a third party? |
Collection agency. |
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In order to sue, what should the plaintiff have completed? |
The plaintiff must have used any and all resources of attempting to collect a debt. |
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Define plaintiff. |
A person who brings a case against another in a court of law. |
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Define defendant. |
A person or entity accused of a crime in criminal prosecution or a person or entity against whom some type of civil relief is being sought in a civil case. |
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Define accounts receivable. |
Entire group of patient ledgers. |
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Define general ledger. |
Core of the practice's financial records. |
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Define patient ledger. |
Chronological accounting of a particular patient's (or family's) activities, including all charges and payments. |
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Define payroll ledger. |
Separate journal offices keep for wages and salaries. |
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Define accounts payable. |
Money owed by a company to its creditors. |
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Define general journal. |
Chronological listing of transactions with a specific format for recording each transaction. |
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Define disbursement journal. |
Listing of all expenses paid out to vendors, such as building rent, office supplies, and salaries. |
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Define daily journal. |
Chronological record of all patient transactions, including pervious balances, charges, payments, and current balances for that day. |
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What service requires a pre-authorization or pre-certification? |
In-patient hospital stay. |
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What is the common error for a claim rejection? |
Wrong codes. |
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What is an EIN? |
Employer Identification Number A nine digit number that serves as a tax payer number. |
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What is term for a claim that has entered the review stage? |
Adjudication. |
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What is an alternative to a suspension file? |
Claims register. |
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What is another name for an EOB? |
Remittance Advice (RA) |
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If a coordination of benefits (COB) exists, what does the biller have to do? |
Ask the patient which insurance is primary and which one is secondary. |
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If there is a secondary insurance policy, which box in the CMS-1500 form would you click/check off? |
Box 11D |
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If a code has been wrongly denied, what can a biller do? |
File an appeal. |
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What must be in a written appeal? |
The beneficiary's name and the insurance claim number. |
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How often should a biller verify a patient's insurance information? |
Every office visit. |
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What do you attach to a paper claim? |
Letter of special instructions with the name of the practice, provider, group number, address and telephone. |
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What should you do when submitting a corrected claim? |
You must put the corrected billing and not a duplicate. |
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What is the time limit for filing a commercial insurance claim? |
365 days. |
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What is it called when spouses both have insurance coverage? |
Coordination of Benefits (COB). |
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What is dual coverage? |
When a single person has two insurances. |
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What is the birthday rule? |
When a child's parents both have separate insurance coverages, the biller must go by the earliest date of birth of the parents to select the primary. |
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What should be done so Medicare can review a claim? |
The person who generated the claim must have their name and credentials on the claim. |
