1.
If an insured is in disagreement with the insurer for the settlement of a claim, a suit must begin within
Correct Answer
C. 3 years
Explanation
If an insured is in disagreement with the insurer for the settlement of a claim, a suit must begin within 3 years. This means that if the insured and insurer cannot come to an agreement on the claim, the insured must file a lawsuit within 3 years from the date of the disagreement. After this time period, the insured may lose their right to pursue legal action against the insurer. It is important for the insured to be aware of this time limit and take appropriate action within the specified timeframe.
2.
If a payment problem develops with an insurance company and the company ignores claims and exceeds time limits to pay a claim, it is prudent to contact the
Correct Answer
B. State insurance commissioner
Explanation
If a payment problem arises with an insurance company and they fail to address claims and surpass the time limits for claim payment, it is advisable to reach out to the state insurance commissioner. The state insurance commissioner is responsible for regulating insurance companies within a specific state and ensuring they comply with state laws and regulations. They can investigate complaints, mediate disputes, and take appropriate actions against the insurance company if necessary. Therefore, contacting the state insurance commissioner would be the appropriate course of action in this situation.
3.
The document together with the payment voucher that is sent to a physician who has accepted assignment of benefits is referred to as a/an
Correct Answer
A. EOB
Explanation
When a physician accepts assignment of benefits, it means that they agree to receive direct payment from the insurance company for the services provided to the patient. In this case, the document that is sent to the physician along with the payment voucher is referred to as an Explanation of Benefits (EOB). The EOB provides a detailed breakdown of the services rendered, the amount billed, the amount covered by insurance, and any remaining balance that may be the responsibility of the patient.
4.
When receiving payment from a private insurance carrier, check the amount of payment on the EOB with the
Correct Answer
A. Patient's financial accounting record
Explanation
The correct answer is to check the amount of payment on the patient's financial accounting record. This is because the financial accounting record keeps track of all the payments received from the private insurance carrier. By comparing the amount mentioned on the Explanation of Benefits (EOB) with the patient's financial accounting record, one can ensure that the correct payment has been received. The other options listed, such as the practice's day sheet, copy of the CMS-1500 form, or the patient's insurance contract, may not provide the accurate payment information needed for verification.
5.
An insurance claims register provides a/an
Correct Answer
C. Follow-up procedures for insurance claims
Explanation
An insurance claims register provides follow-up procedures for insurance claims. This means that it includes a systematic process or set of steps that are followed after an insurance claim has been submitted. These procedures may include tasks such as verifying the claim, investigating the details, communicating with the insured party, processing the claim, and making the necessary payments or settlements. The register helps to ensure that all claims are properly handled and followed up on, allowing for efficient and effective claims management within the insurance company.
6.
Pending or resubmitted insurance claims may be tracked through a
Correct Answer
A. Tickler file
Explanation
A tickler file is a system used to track pending or resubmitted insurance claims. It is a file or set of files that contains reminders or prompts for future actions or follow-ups. In the context of insurance claims, a tickler file would be used to keep track of claims that are still pending or need to be resubmitted. This helps ensure that these claims are not forgotten or overlooked and allows for timely follow-up and resolution. A tickler file is a useful tool for organizing and managing tasks and deadlines in various industries, including insurance.
7.
A follow-up effort made to an insurance company to locate the status of an insurance claim is called a/an
Correct Answer
D. Both inquiry and tracer
Explanation
Both an inquiry and a tracer are follow-up efforts made to an insurance company to locate the status of an insurance claim. An inquiry is a request for information or clarification about the claim, while a tracer is a more formal and detailed investigation into the claim's status. Both methods aim to gather information and ensure the claim is being processed correctly.
8.
If an insurance claim has been lost by the insurance carrier, the procedure(s) to follow is to
Correct Answer
D. All of the above
Explanation
If an insurance claim has been lost by the insurance carrier, the procedure(s) to follow would be to ask if there is a backlog of claims at the insurance office, submit a copy of the original claim, and verify the correct mailing address. These steps are necessary to ensure that the claim is properly processed and not lost again. By asking about a backlog, it allows the insured to understand if there may be delays in processing claims. Submitting a copy of the original claim helps provide the necessary documentation for the insurance carrier to review. Verifying the correct mailing address ensures that any future correspondence or payments are sent to the correct location. Therefore, all of the above options are necessary in this situation.
9.
An insurance claim with an invalid prodecure code would be
Correct Answer
B. Rejected
Explanation
If an insurance claim has an invalid procedure code, it would be rejected. This means that the claim will not be accepted or approved for payment by the insurance company. The invalid procedure code indicates that the medical service or treatment being claimed is not covered or recognized by the insurance policy. As a result, the claim is denied and the policyholder will not receive any reimbursement or coverage for that particular procedure.
10.
What should you do if an insurance carrier requests information about another insurance carrier?
Correct Answer
A. Provide the information
Explanation
If an insurance carrier requests information about another insurance carrier, the correct action to take is to provide the information. This means that you should gather the necessary details and share them with the requesting insurance carrier. This could include policy numbers, coverage details, and any other relevant information that may assist in coordinating benefits or resolving any issues between the two carriers. By providing the information, you are facilitating effective communication and cooperation between the insurance carriers.
11.
An insurance claim with a bundled service would be
Correct Answer
A. Paid
Explanation
When an insurance claim has a bundled service, it means that multiple services or treatments are combined into a single claim. In this case, the insurance company would pay for the bundled service, as long as it meets the policy's coverage criteria.
12.
What should be done if an insurance claim denial is received because a billed service was not a program benefit?
Correct Answer
C. Send the patient a statement with a notation of the response from the insurance company
Explanation
If an insurance claim denial is received because a billed service was not a program benefit, the appropriate action would be to send the patient a statement with a notation of the response from the insurance company. This is necessary to inform the patient about the denial and provide them with an explanation from the insurance company. It also allows them to understand the reason for the denial and take necessary actions, such as appealing the decision or seeking alternative payment options.
13.
What should be done if an insurance company denies a service stating it was not medically necessary and the physician believes it was?
Correct Answer
D. Appeal the decision with a statement from the pHysician
Explanation
If an insurance company denies a service stating it was not medically necessary and the physician believes it was, the appropriate action would be to appeal the decision with a statement from the physician. This is because the physician can provide additional information and evidence to support their belief that the service was indeed medically necessary. By appealing the decision, there is a chance that the insurance company may reconsider and approve the claim.
14.
When downcoding occurs, payment will
Correct Answer
C. Be less
Explanation
When downcoding occurs, payment will be less. Downcoding refers to the process of reducing the level or complexity of a billed service by a healthcare provider. This can happen when the documentation or medical records do not support the level of service that was initially billed. As a result, the insurance company or payer may reimburse the provider at a lower rate, leading to a decrease in payment.
15.
If an insurance company admits that a patient signed an assignment of benefits document and that it inadvertently paid the patient instead of the physician, the insurance company should
Correct Answer
B. Pay the pHysician within 2 to 3 weeks and honor the assignment even before the company recovers their money from the patient
Explanation
The correct answer is to pay the physician within 2 to 3 weeks and honor the assignment even before the company recovers their money from the patient. This is because the insurance company admits that they made a mistake by paying the patient instead of the physician. Therefore, it is their responsibility to rectify the error by paying the physician promptly and honoring the assignment of benefits. Waiting for the company to recover the money from the patient before paying the physician would be an unnecessary delay and unfair to the physician.
16.
The total number of levels of redetermination that exist in the Medicare program is
Correct Answer
C. Five
Explanation
In the Medicare program, there are five levels of redetermination. Redetermination is the process of reviewing and reconsidering a claim or decision that has been made. These levels include reconsideration by a Qualified Independent Contractor (QIC), hearing by an Administrative Law Judge (ALJ), review by the Medicare Appeals Council (MAC), review by a federal district court, and review by a federal appeals court. These levels provide multiple opportunities for a claim or decision to be reviewed and potentially changed.
17.
The first level of appeal in the Medicare program is
Correct Answer
A. Redetermination
Explanation
The first level of appeal in the Medicare program is redetermination. This means that if a Medicare claim is denied, the beneficiary or their healthcare provider can request a redetermination, which is a review of the claim by a different Medicare claims examiner. During the redetermination process, additional information or evidence can be submitted to support the claim. This level of appeal allows for a reconsideration of the initial decision and provides an opportunity to address any errors or misunderstandings that may have occurred.
18.
The correct method to send documents for a Medicare reconsideration (Level 2) is by
Correct Answer
A. Certified mail with return receipt requested
Explanation
The correct method to send documents for a Medicare reconsideration (Level 2) is by certified mail with return receipt requested. This method ensures that the sender has proof of mailing and delivery, as the recipient must sign for the mail and the sender receives a receipt as evidence. This is important for important and time-sensitive documents like Medicare reconsideration requests, as it provides a record of the communication and helps to ensure that the documents are received and processed in a timely manner.
19.
A request for a Medicare administrative law judge hearing can be made if the amount in controversy is at least
Correct Answer
A. $100
Explanation
A request for a Medicare administrative law judge hearing can be made if the amount in controversy is at least $100. This means that if the disputed amount between the Medicare beneficiary and the Medicare program is equal to or greater than $100, the beneficiary has the right to request a hearing before an administrative law judge. This allows the beneficiary to present their case and have a fair review of the decision made by the Medicare program.
20.
How many levels of review exist for TRICARE appeal procedures?
Correct Answer
C. Three
Explanation
TRICARE appeal procedures have three levels of review. This means that if an individual is dissatisfied with the decision made at the initial level, they have the option to request a review at two additional levels. This allows for a thorough and fair assessment of the appeal, ensuring that all parties involved have the opportunity to present their case and have it reviewed multiple times if necessary.
21.
TRICARE appeals are normally resolved within
Correct Answer
C. 60 days
Explanation
TRICARE appeals are typically resolved within 60 days. This means that once an appeal is filed, it generally takes up to 60 days for a decision to be made and communicated to the individual. This timeframe allows for a thorough review of the appeal and ensures that a fair and accurate decision is reached. It also provides the necessary time for any additional information or documentation to be gathered and considered before reaching a resolution.
22.
In a TRICARE case, a request for an independent hearing may be pursued if the amount in question is
Correct Answer
B. $300 or more
Explanation
In a TRICARE case, a request for an independent hearing may be pursued if the amount in question is $300 or more. This means that if the disputed amount is $300 or higher, the person involved in the TRICARE case has the right to request an independent hearing to further discuss and resolve the issue.
23.
Cash flow is
Correct Answer
C. The ongoing availability of cash in the medical practice
Explanation
Cash flow refers to the ongoing availability of cash in the medical practice. It represents the movement of money into and out of the practice, including revenue from patients, insurance payments, and other sources, as well as expenses such as salaries, rent, and supplies. It is important for the practice to have a positive cash flow to ensure smooth operations, pay bills on time, and have funds available for investments or emergencies. Monitoring and managing cash flow is crucial for financial stability and success in the medical practice.
24.
When insurance carriers do not pay claims in a timely manner, what effect does this have on the medical practice
Correct Answer
B. Decreased cash flow
Explanation
When insurance carriers do not pay claims in a timely manner, it has a negative effect on the medical practice's cash flow. This means that the practice will have less money coming in, which can lead to financial difficulties. It may result in delays in paying suppliers and employees, difficulty in purchasing necessary equipment or supplies, and overall financial instability. This can also impact the ability of the practice to provide quality care to patients and meet their needs effectively.
25.
What does the insurance billing specialist need to monitor to be able to evaluate the effectiveness of the collection process
Correct Answer
D. Accounts receivable
Explanation
The insurance billing specialist needs to monitor accounts receivable in order to evaluate the effectiveness of the collection process. This is because accounts receivable represents the amount of money owed to the company by its customers for services provided. By monitoring accounts receivable, the specialist can track the amount of outstanding payments and determine if the collection process is efficient in collecting these payments.
26.
The average amount of accounts receivable should be
Correct Answer
A. 1.5 to 2 times the charges for 1 month of services
Explanation
The correct answer is 1.5 to 2 times the charges for 1 month of services. This means that the average amount of accounts receivable should be between 1.5 and 2 times the charges for 1 month of services. This range allows for a reasonable amount of outstanding payments while still maintaining a healthy cash flow for the business. Having a higher average amount of accounts receivable could indicate that the business is struggling to collect payments, while having a lower average could suggest that the business is not maximizing its revenue potential.
27.
Accounts that are 90 days or older should not exceed
Correct Answer
C. 15% to 18% of the toal accounts receivable
Explanation
Accounts that are 90 days or older should not exceed 15% to 18% of the total accounts receivable. This means that a company should aim to keep the amount of overdue accounts within this range to maintain a healthy cash flow and minimize the risk of bad debts. If the percentage exceeds 18%, it may indicate a problem with the company's credit policies or collection procedures, and if it falls below 15%, it may suggest that the company is too strict in its credit policies, potentially losing out on sales opportunities.
28.
What should be done to inform a new patient of office fees and payment policies
Correct Answer
D. All of the above
Explanation
To inform a new patient of office fees and payment policies, all of the above options should be done. Sending a patient information brochure can provide detailed information about the fees and policies, allowing the patient to review it at their convenience. Sending a confirmation letter can serve as a reminder and also include the necessary information about fees and policies. Finally, discussing fees and policies at the time of the initial contact ensures that the patient is aware of the financial aspects before proceeding with any treatment.
29.
The patient is likely to be the most cooperative in furnishing details necessary for a complete registration process
Correct Answer
A. Before any services are provided
Explanation
Before any services are provided, the patient is likely to be the most cooperative in furnishing details necessary for a complete registration process. This is because at this stage, the patient has not yet received any services or treatment, so they are more likely to be focused on providing accurate and complete information for the registration process. Once services are provided or after the first statement, the patient may be preoccupied with their medical condition or the treatment they have received, making it less likely for them to be as cooperative in providing the necessary details. Similarly, in a follow-up telephone call, the patient may not have the same level of attention or willingness to provide the required information as they would have before any services were provided.
30.
The reason for a fee reduction must be documented in the patient's
Correct Answer
A. Financial accounting record
Explanation
The reason for a fee reduction must be documented in the patient's financial accounting record because this record is specifically used to track and document all financial transactions related to the patient's healthcare services. It includes details about fees charged, payments made, and any adjustments or discounts applied. By documenting the reason for a fee reduction in the financial accounting record, healthcare providers can ensure transparency and accuracy in their financial records, as well as provide a clear audit trail for any future reference or verification.
31.
Professional courtesy means
Correct Answer
D. Making no charge to anyone, patient or insurance company, for medical care
Explanation
Professional courtesy means making no charge to anyone, patient or insurance company, for medical care. This term refers to a situation where a healthcare provider offers their services without expecting any payment in return. It is often extended to other healthcare professionals or their family members as a professional courtesy. This practice is based on the idea of mutual respect and support within the healthcare community. By providing medical care without charge, professionals demonstrate their commitment to the well-being of their colleagues and the overall healthcare system.
32.
When collecting fees, your goal should always be to
Correct Answer
C. Collect the full amount
Explanation
When collecting fees, the goal should always be to collect the full amount. This ensures that the business or organization receives the full payment for their services or products. Collecting only half the fee may result in financial loss, and collecting as much as possible may be seen as unethical or unfair. Leaving the impression of being a nice person is important, but it should not compromise the collection of the full amount owed.
33.
A medical practice has a policy of billing only for charges in excess of $50. When the medical assistant requests $45 payment for the office visit, the patient states, "just bill me." How should the medical assistant respond
Correct Answer
B. State the office policy and ask for the full fee
Explanation
The medical assistant should state the office policy and ask for the full fee because the policy of the medical practice is to bill only for charges in excess of $50. Therefore, the patient should be informed about the policy and asked to pay the full fee for the office visit.
34.
The most common method of payment in the medical office is
Correct Answer
A. Personal check
Explanation
The most common method of payment in the medical office is a personal check. This is because personal checks are widely accepted and provide a convenient way for patients to pay for their medical expenses. Additionally, personal checks offer a paper trail and can be easily tracked for record-keeping purposes. They also eliminate the need for patients to carry large amounts of cash or rely solely on electronic payment methods such as credit or debit cards.
35.
When the physician's office receives notice that a check was not honored, the first thing to do is to
Correct Answer
C. Call the bank or the patient
Explanation
When the physician's office receives notice that a check was not honored, the first thing to do is to call the bank or the patient. This is necessary to clarify the situation and determine the reason for the dishonored check. By contacting the bank or the patient, the physician's office can gather information about any potential issues with the check, such as insufficient funds or an error in processing. This step allows the office to address the problem promptly and find a resolution, whether it involves requesting a new payment method or resolving any banking issues.
36.
Accounts receivable are usually aged in time periods of
Correct Answer
B. 30,60,90, and 120 days
Explanation
Accounts receivable are usually aged in time periods of 30, 60, 90, and 120 days. This means that the company categorizes its outstanding invoices based on how long they have been outstanding. By aging the accounts receivable, the company can track the aging of its receivables and identify any potential issues with collecting payment from customers. The aging process helps the company prioritize its collection efforts and take appropriate actions to ensure timely payment.
37.
Messages included on statements to promote payment are called
Correct Answer
C. Dun messages
Explanation
Dun messages are included on statements to promote payment. These messages are typically used to remind customers about their outstanding balance and urge them to make a payment. They can be seen as a form of gentle persuasion or a reminder to encourage prompt payment.
38.
What is the type of billing system in which practice management software is used
Correct Answer
C. Computer billing
Explanation
The correct answer is computer billing. This type of billing system involves the use of practice management software to automate and streamline the billing process. It allows healthcare providers to generate and submit electronic claims, track payments, and manage patient billing information efficiently. This eliminates the need for manual billing methods and increases accuracy and efficiency in the billing process.
39.
Employment of a billing service is called
Correct Answer
C. Outsourcing
Explanation
Outsourcing refers to the practice of hiring an external company or service to handle specific tasks or functions that were previously performed in-house. In the context of the given question, the employment of a billing service involves outsourcing the billing process to a third-party service provider. This allows the organization to delegate the responsibility of billing to a specialized service, which can help streamline operations, reduce costs, and improve efficiency.
40.
The first statement should be
Correct Answer
A. Presented at the time of service
Explanation
The correct answer is "presented at the time of service". This means that the first statement should be given or shown to the relevant party at the moment the service is being provided. It suggests that the statement is not meant to be sent or mailed after the service has been completed, but rather should be presented in person during the service itself.
41.
What is a card called that permits bank customers to make cashless purchases from funds on deposit without incurring revolving finance charges for credit
Correct Answer
C. Debit card
Explanation
A debit card is a type of card that allows bank customers to make purchases using the funds they have deposited in their bank account, without incurring any revolving finance charges for credit. Unlike a credit card, which allows users to borrow money and pay it back later, a debit card deducts the purchase amount directly from the user's bank account. This means that the user is using their own money, rather than borrowing from the bank, and therefore does not have to pay any interest or finance charges.
42.
How many installments (excluding a down payment) must a payment plan have to require full written disclosure
Correct Answer
B. Four or more
Explanation
A payment plan must have four or more installments (excluding a down payment) in order to require full written disclosure. This means that if a payment plan has three or fewer installments, it does not need to provide full written disclosure. However, if the payment plan has four or more installments, it is required to provide full written disclosure to ensure transparency and protect the consumer.
43.
What is the name of the federal act that prohibits discrimination in all areas of granting credit
Correct Answer
A. Equal Credit Opportunity Act
Explanation
The correct answer is the Equal Credit Opportunity Act. This federal act prohibits discrimination in all areas of granting credit, ensuring that all individuals have equal access to credit regardless of their race, color, religion, national origin, sex, marital status, age, or receipt of public assistance. This act promotes fairness and equal opportunities in the credit industry.
44.
What is the name of the act designed to address the collection practices of third-party debt collectors
Correct Answer
D. Fair Debt Collection Practices Act
Explanation
The Fair Debt Collection Practices Act is the correct answer because it is the act specifically designed to regulate and address the collection practices of third-party debt collectors. This act establishes guidelines and restrictions on how debt collectors can communicate with debtors, what information they can disclose, and how they can pursue debt collection. It aims to protect consumers from abusive, deceptive, and unfair practices in debt collection. The other options listed are acts that address different aspects of consumer credit and protection, but they do not specifically target third-party debt collectors.
45.
All collection calls should be placed
Correct Answer
B. After 8 AM and before 9 PM
Explanation
Collection calls should be made during reasonable hours, which typically range from 8 AM to 9 PM. This allows for a reasonable window of time to contact individuals without disturbing them too early in the morning or too late at night. Therefore, the correct answer is "after 8 AM and before 9 PM".
46.
Which group of accounts would a collector target when he or she begins making telephone calls
Correct Answer
B. 60-90 day accounts
Explanation
A collector would target 60-90 day accounts when making telephone calls because these accounts are relatively recent and have a higher likelihood of being collectible. Accounts that are too new (30-60 days) may still be within the grace period, while accounts older than 90 days may have already been handed over to a collections agency or deemed uncollectible. Therefore, focusing on 60-90 day accounts allows the collector to prioritize their efforts on accounts that are more likely to yield successful collections.
47.
In making collection telephone calls to a group of accounts, how should the accounts be organized to determine where to begin
Correct Answer
C. Organize the accounts according to amounts owed and start with the largest amount
Explanation
The best approach to determine where to begin making collection telephone calls to a group of accounts is to organize the accounts according to amounts owed and start with the largest amount. This ensures that the accounts with the highest outstanding balances are prioritized, as they are likely to have a higher urgency for collection. This method maximizes the potential for successful collections and helps to efficiently allocate resources.
48.
A plan in which employees can choose their own working hours from within a broad range of hours approved by management is called
Correct Answer
A. Flex time
Explanation
Flex time refers to a work arrangement where employees have the flexibility to choose their own working hours within a range of hours approved by management. This allows employees to have a better work-life balance and accommodate personal commitments. It also promotes productivity and employee satisfaction as they can work during their most productive hours. This arrangement is beneficial for both employees and employers as it fosters a more flexible and accommodating work environment.
49.
When writing a collection letter
Correct Answer
B. Use a friendly tone and ask why payment has not been made
Explanation
When writing a collection letter, it is recommended to use a friendly tone and ask why payment has not been made. This approach helps to maintain a positive relationship with the patient while addressing the issue of non-payment. By using a friendly tone, the letter conveys concern and understanding, which may prompt the patient to provide an explanation for the delay in payment. This approach is more likely to result in a productive and respectful conversation about the outstanding payment, rather than making assumptions or accusations about the patient's intentions or oversight.
50.
"Netback" is a term used to describe
Correct Answer
C. A collection agency's performance
Explanation
The term "netback" refers to a collection agency's performance. It is a measure of the agency's effectiveness in collecting money owed by delinquent accounts. A high netback indicates that the agency has successfully recovered a significant portion of the outstanding debts, while a low netback suggests that the agency has not been successful in collecting the money owed. This term is commonly used in the financial industry to assess the performance and efficiency of collection agencies.