Filling Part 2
the files of patients currently receiving treatment
Active files
What stage is the revenue cycle considered complete?
A. Registration and scheduling
B. Payer adjudication
C. health care encounter and documentation
D. posting the payment
Posting the payment
A medical administrative assistant notices a difference between the billed and allowed amount. Which of the following types of transactions must be posted in the patient account?
A. Hardship write-off
B. Contractual adjustment
C. Payment posting
D. Charge entry
D. Charge entry
electronic health record of health related information about a patient that can be created, managed and reviewed by authorized providers and staff from MORE THAN ONE health care organization
EHR
A Medicare beneficiary has enrolled in a health plan that offers inpatient, outpatient, vision, and dental coverage. In which of the following types of health plan is the beneficiary enrolled?
A. Medicare Part A
B. Medicare Part B
C. Medicare Part C
D. Medicare Part D
C. Medicare Part C
are those patients who have died, moved away, or terminated their relationship with the provider
Closed files
A medical administrative assistant is contacting the insurance payer to determine benefits coverage for a procedure and is requesting approval. Which of the following steps of the revenue cycle is being performed?
A. Appeal
B. Payer adjudication
C. Eligibility and insurance preauthorization
D. Encounter documentation
C. Eligibility and insurance preauthorization
A provider agrees to accept the payer’s allowed amount. What is the provider’s status?
A. Non-participating provider
B. Eligible
C. Participating provider
D. Value-based
C. Participating provider
single access to provider -more secure than paper records -electronic health record of health information that is created, added to, managed and reviewed by authorized providers and staff within a SINGLE health care organization
EMR
A Provider is rewarded via a bonus when quality and performance measures are met. This is an example of which of the following types of payment models.
A. PAR Provider
B. Pay for Performance
C. Fee for service
D. Capitation
Pay for Performance
the files of patients whom the provider has not seen for 6 months or longer
Inactive files
A provider is paid a set amount for each member per month. This is an example of which of the following types of payment models?
A. Value-based payment model
B. Medicare Advantage Plan
C. Fee-for-service
D. Capitation
D. Capitation
A fee-for-service Medicare patient arrives at a provider’s office for medical services related to otitis media. Which of the following parts of Medicare should be billed?
A. Part A
B. Part B
C. Part C
D. Part D
B. Part B
How often should a medical administrative assistant perform charge reconciliation
A. Yearly
B. daily
C. monthly
D. weekly
Daily
A provider is reimbursed for services rendered using CPT and ICD-10-CM codes. This is an example of which of the following types of payment models?
A. Value-based payment model
B. Capitation
C. Pay-for-performance
D. Fee-for-service
D. Fee-for-service
A medical administrative assistant notices that no payments from a certain third-party payer have been received in the past month. Which type of report should the assistant review to determine the status of the submitted claims?
A. Patient aging report
B. Insurance aging report
C. Daily transaction report
D. Patient statements
B. Insurance aging report
A medical administrative assistant is checking with a patient’s insurance payer to determine if a referral or preauthorization is needed prior to performing an MRI. This action occurs in which of the following phases of the revenue cycle?
A. Payer adjudication
B. Appeals and claims collection
C. Charge capture and coding
D. Utilization management review
D. Utilization management review
A schedule is made for patients to have PEs on Tuesday afternoons and Thursday mornings. This is an example of which type of scheduling?
cluster
Which of the following is the set amount established by an insurance payer for an office visit and should be collected at the time of the encounter?
A. Premium
B. Deductible
C. Copay
D. Coinsurance
C. Copay
Which of the following is a function of a clearinghouse?
A. Claims adjudication
B. Submits claims to the third-party payer
C. Files appeals
D. Performs charge capture and coding
B. Submits claims to the third-party payer
Which of the following forms is used to report claims to a third-party payer from a provider’s office?
A. UB-04
B. CMS-1500
C. ABN form
D. Patient registration form
B. CMS-1500
A medical administrative assistant is reviewing remittance advice to determine how claims have been paid and to see if any errors have been made by the third-party payer. This action occurs in which of the following phases of the revenue cycle?
A. Receiving and posting reimbursement
B. Payer adjudication
C. Appeals and claims collections
D. Health care encounter and documentation
D. Health care encounter and documentation
Which of the following codes are reported on the claim form to represent the conditions managed at the time of the visit and are required by the third-party payer for claims processing?
A. HCPCS
B. CPT
C. DRG
D. ICD-10-CM
D. ICD-10-CM
Which of the following patients is considered Medicare eligible?
A patient who has any chronic disease
A patient who is under 65 years of age
A patient who has an acute medical condition
A patient diagnosed with end-stage renal disease
A patient diagnosed with end-stage renal disease
A third-party payer’s policy for the length of time to submit claims is known as which of the following?
A. Charge entry
B. Timely filing
C. Claims submission
D. Payment posting
B. Timely filing