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Exam 4: Processing an Insurance Claim

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Question 31

Multiple Choice

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Which amended the Truth in Lending Act and requires credit and charge card issuers to provide certain disclosures in direct mail, telephone, and other applications and solicitations for open-ended credit and charge accounts and under other circumstances?

A) Fair Credit and Charge Card Disclosure Act
B) Fair Credit Billing Act
C) Fair Credit Reporting Act
D) Fair Debt Collection Practices Act

E) C) and D)
F) A) and B)

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Question 32

Multiple Choice

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The patient underwent office surgery on March 18, and the third-party payer determined the allowed charge to be $1,480. The patient paid the 20 percent coinsurance at the time of the office surgery. The physician and patient each received a check for $1,184, and the patient signed her check over to the physician. The overpayment was __________, and the physician must reimburse the third-party payer.

A) $296
B) $1,184
C) $1,480
D) $2,368

E) A) and C)
F) A) and B)

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Question 33

Multiple Choice

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Covered entities are required to use mandated national standards when conducting any of the defined transactions covered under HIPAA. Which is an example of a covered entity?

Which is the percentage the patient pays for covered services after the deductible has been met and the copayment has been paid?

One reason to track unpaid claims is due to the payment error in which a patient erroneously cashes a check made out to both patient and provider, which is called a __________.

Which is a manual permanent record of all financial transactions between the patient and the practice?

The delinquent claim cycle advances through aging periods, and providers typically focus __________ recovery efforts for older delinquent claims.

Which is the practice of submitting multiple CPT codes when just one code should have been submitted?

Medicare calls its remittance advice a(n) __________.

A nonparticipating provider (nonPAR) is an out-of-network provider who does not contract with the insurance plan, and patients who elect to receive care from non-PARs will incur higher out-of-pocket expenses. The patient __________ expected to pay the difference between the insurance payment and the provider's fee.

Providers have the option of arranging for __________, which means that payers deposit reimbursement for health care services to the provider's account electronically.

Which means the provider agrees to accept what the insurance company allows or approves as payment in full for the claim?

The manual daily accounts receivable journal is also known as the __________, and it is a chronologic summary of all transactions posted to individual patient ledgers/accounts on a specific date.

Which is the assignment of lower-level codes than documented in the record?

A delinquent account is also called a __________ account, which means it is one that has not been paid within a certain time frame (e.g., 120 days) . Following up on such delinquent accounts is crucial to the success of the business.

Which protects information collected by consumer reporting agencies such as credit bureaus, medical information companies, and tenant screening services?

Which prohibits discrimination on the basis of race, color, religion, national origin, sex, marital status, age, receipt of public assistance, or good-faith exercise of any rights under the Consumer Credit Protection Act?

Which is the electronic or manual transmission of claims data to payers or clearinghouses for processing?

Which amended the Truth in Lending Act and requires prompt written acknowledgment of consumer billing complaints and investigation of billing errors by creditors?

A child is listed as a dependent on both his father's and his mother's group insurance policies. The father's birth date is March 20, 1977, and the mother's birth date is March 6, 1979. Which policy is primary?