Patient Appointments
What is the first thing that an MA should do when a patient comes in for a scheduled appointment?
The MA will verify patient eligibility, identification, and insurance information. They will ask to see a photo identification, such as a state identification card or driver’s license, to ensure that the name matches the information on the insurance card and the information in the demographic section of the EHR.
Which of the following can be used to verify a patient’s identification?
A photo identification, such as a driver’s license, will verify identification of the patient. A utility bill, Social Security card, or car registration does not prove the identification of the patient.
Which of the following is included on the encounter form (superbill)?
Reason for the visit
What is the difference between precertification and preauthorization?
Precertification is a request to determine if a service is covered by the patient’s policy. Preauthorization is sometimes required by the patient’s insurance company to determine medical necessity for the proposed services.
Which of the following methods can be used to request a referral?
Electronic via EHR, Website, Phone call
What is real-time adjudication?
A tool that allows for a submission of the coded visit to the insurance company by participating providers for reimbursement decisions by third-party payers while the patient is present.
What could result from missing or inaccurate demographic information at check-in?
Claim denials can occur due to missing, incomplete, or inaccurate demographic information
Besides providing effective medical care, what are two other uses for patient medical records?
billing a third-party payer and supporting research efforts to improve overall health
What might happen if utilization review is not completed before a scheduled procedure?
If utilization review is not completed, the insurance company may deny payment for the procedure, leaving the patient responsible for the full cost.
What methods can be used to verify patient eligibility?
Patient eligibility can be verified by calling the insurance or using an eligibility application in the EHR or the payer’s web-based verification service.
This system schedules multiple patients in the same time period, perhaps the top of the hour or within the first 30 minutes, and then patients are seen based upon who arrives first. This gives more flexibility within each hour.
Wave schedule
What two items should be scanned into the system during the check-in process?
The insurance card and a valid state photo identification
What should we do when corrections are made on patient medical records?
Add a correcting entry or addendum or by drawing a line through data and adding new data
What is a CPT code ?
Current Procedural Terminology codes that identify medical services and procedures performed by a provider
Which of the following is an example of a diagnosis?
Diagnosis describes the condition, cause, manifestation, location, severity, and type of injury or disease.
Laceration of abdominal wall
Glina has come in for her 9 am appointment at the Otologists office, she has not received services from the provider within 3 years, what type of appointment should the MA put Glina under?
New appointment
When verifying insurance eligibility, what should the MA also determine?
Any copayments or patient financial responsibilities to be collected before services are rendered
What is a patient-flow sheet?
Records and tracks patient health data, such as vitals or lab results
Which of the following is an example of cycle billing?
Billing patients in segments
Which of the following is a goal of interoperability?
Exchange of information
Which of the following methods of scheduling categorizes patients into groups with similar medical needs?
Cluster
When is it more efficient to collect patient payments: before or after the appointment?
Before the appointment
What do Electronic health records include?
interactive flow sheets that streamline continuity of care and assist with management of the patient’s medical conditions
Precertification can be obtained by verifying the patient’s benefits during the eligibility check
Describe the purpose of reconciling a patient’s financial records.
Reconciliation is the process of ensuring that the accounts are all balanced and accurate. The amounts must be accurate and recorded to the correct patient account so that current balances are updated and the patient financial responsibilities are provided via a statement to collect the amount due.