5 Written Questions

1. a payer's review and reduction of a procedure code (often an E/M code) to a lower level than reported by the provider
2. a report grouping unpaid claims transmitted to payers by the length of time that they remain due, such as 30, 60, 90, or 120 days
3. the health plan that pays benefits after the primary plan when a patient is covered by more than one plan
4. in an electronic claim, a computer check for missing data or other mistakes, such as outdated codes
5. a claim that is accepted by a health plan for adjudication

5 Matching Questions

1. uncollectible account
2. accounts receivable (AR)
3. adjudication
4. appeal
5. real-time claims adjudication (RTCA)

1. a electronic health insurance claim processed at patient check-out; allows practice to know what the patient will owe for the visit
2. b the process followed by health plans to examine claims and determine benefits
3. c a request sent to a payer for reconsideration of a claim adjudication
4. d monies owed to a medical practice by its patients and third-party payers
5. e monies that cannot be collected from the practice's payers or patients and must be written off

5 Multiple Choice Questions

1. a report grouping unpaid patient's bills by the length of time that they remain due, such as 30, 60, 90, or 120 days
   1. insurance aging report
   2. patient aging report
   3. patient statement
   4. patient ledger
2. a report that shows the services provided to a patient, the total payments made, total charges, adjustments, and the balance due
   1. adjustments
   2. patient aging report
   3. patient ledger
   4. patient statement
3. the health plan that pays benefits first when a patient is covered by more than one plan
   1. determination
   2. primary insurance
   3. secondary insurance
   4. birthday rule
4. report from a receiver of an electronic claim transmitted to its sender regarding the status and completeness of the claim
   1. patient aging report
   2. adjudication
   3. clean claim
   4. audit/edit claim response
5. a record of all charges and payments made on a particular patient's account
   1. patient aging report
   2. patient ledger
   3. appeal
   4. patient statement

5 True/False Questions

1. adjustments → the process followed by health plans to examine claims and determine benefits

   True        False

2. electronic data interchange (EDI) → the exchange (system to system) of data in a standardized format

   True        False

3. birthday rule → the guideline that determines which of two parents with medical coverage has the primary insurance for a child; the parent whose day of birth is earlier in the calendar year is considered primary

   True        False

4. electronic funds transfer (EFT) → the exchange (system to system) of data in a standardized format

   True        False

5. coordination of benefits (COB) → a clause in an insurance policy that explains how the policy will pay if more than one insurance policy applies to the claim

   True        False