Medical Insurance Billing Chapter 3 Quiz
Terms in this set (36)
NonPAR stands for:
After one health plan has paid on a claim, which insurance makes the next payment, if applicable?
The first health plan to pay when more than one plan is in effect is called the
If a patient has coverage under two insurance plans, one under which the patient is the policyholder and one under which the patient is a dependent, the primary plan is:
the patient's plan
--If a patient has coverage under two insurance plans, one under which the patient is the policyholder and one under which the patient is a dependent, the patient's own plan is primary--
Assignment of benefits authorizes:
the physician to file claims for a patient and receive direct payments from the payer
If an employed patient has coverage under two insurance plans, one the employer's plan and the other a government plan, the primary plan is:
the employer's plan
If a provider has agreed to accept assignment, he/she will:
accept what the insurance allows
Determine how a policyholder can authorize physicians to submit claims on their behalf and receive payments directly from payers.
signing and dating an assignment of benefits statement
What does COB stand for in medical insurance terms?
coordination of benefits
Another term for prior authorization is
What type of provider is required to have patients sign an acknowledgment?
--Only a direct provider is required to have patients sign an acknowledgment--
If a retired patient with Medicare also has coverage under a working spouse's plan, the primary plan is:
the spouse's plan
--If a retired patient with Medicare also has coverage under a working spouse's plan, the spouse's plan is primary--
What do payers issue when they approve a service?
prior authorization number
If a patient authorizes a provider to accept assignment, what can the provider now do on their behalf?
file claims for the patient and receive payments directly from the payer
Charging TOS payments depends on:
the provision of their health plan and practice's financial policy
--What patients owe at the time they receive professional services depends on the practice's financial policy and on the provisions of their health plan--
An established patient is defined as one who has seen the provider within the last
What type of information is included in a patient's social history?
smoking, alcohol use, and exercise habits
What is set up in the practice management program when a patient's chief complaint is different than the one for a previous encounter?
--Usually a new case or record for an established patient is set up in the practice management program when the patient's chief complaint for an encounter is different than the previous chief complaint--
A patient's insurance card usually shows:
member identification number
--A patient's insurance card does not show the payer's representative's name, previous employer, or date of first payment--
The practice's rules for payment for medical services are found in their:
What type of charges do practices routinely collect at the time of service?
copays, noncovered, and self-pay patients
--Practices routinely collect the following charges at the time of service: previous balances, copayments or coinsurance, noncovered or overlimit fees, charges of nonparticipating providers, charges for self-pay patients, deductibles for patients with consumer-driven health plans (CDHPs)--
Patients may have fill-in-the-gap insurance called:
The terms "subscriber" and "guarantor" have the same meaning as:
A new patient is defined as one who has NOT seen the provider within the last
What Medicare form is used to show charges to patients for noncovered services?
Advance Beneficiary Notice
--Medicare provides a form, called an Advance Beneficiary Notice (ABN), that must be used to show charges to the patient--
The document patients sign to signify that they have read and understood how the provider will protect their PHI is the
Acknowledgment of Receipt of Notice of Privacy Practices
The initial step in establishing financial responsibility is to:
verify the payer's rules for the medical necessity of the planned service
For assigned claims, the payment for services rendered is expected:
after the patient receives a statement
--For assigned claims you will be billed for any amount you owe--
Another term for the insured is:
A "self-pay" patient is one who:
A provider who directly treats a patient is called a(n)
In what order are benefits typically determined when the parents do not have joint custody arrangements?
plan of custodial parent, plan of spouse of custodial parent, plan of parent without custody
--If the parents do not have joint custody of the child, unless otherwise directed by a court order, benefits are determined by the plan of the custodial parent, the plan of the spouse of the custodial parent (if remarried), and the plan of the parent without custody--
A provider such as a facility who does not have face-to-face interaction with a patient is called a(n):
For unassigned claims, the payment for services rendered is expected:
at the time of service
--Payment for the physician's services is expected at the end of your appointment for unassigned claims--
What information does RTCA allow the practice to view?
the amount the health plan will pay and amount patient will owe
--Real-time claims adjudication (RTCA) allows the practice to view, at the time of service, what the health plan will pay for the visit and what the patient will owe--
Which of the following is another common term for encounter forms?
all of these are correct
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