The Insured
The insurance company is also known as the _.
carrier
The oldest form of managed care is _.
HMO
You should not call a patient for the purpose of debt collection on a
Sunday
_ is the practice of billing the patient for the amount not covered by insurance.
Balance billing
Cindy has insurance that does not require referrals to specialists. She most likely has a _.
PPO
Certain amount of allowable or covered medical expense the insured must incur before the insurance carrier will begin paying benefits
deductable
What type of code is used to report what is wrong with the patient or what brought the patient to see the physician?
ICD-10 diagnostic code
Attempted collection of a debt by telephone cannot be made after
9 pm
What type of payment from insurance company to the provider is made in advance of service rendered?
capitation
Listed on an account are the father, the mother, and two minor children. One insurance policy, held by the mother, covers all four family members. Who is the guarantor on the account?
mother
Medicare Part A
hospital insurance
What type of code is used for reporting each procedure and service that the physician has documented in treating the patient?
procedure codes, CPT/HCPS
Statutes of limitations for collecting debt are set by the
state.
A(n) _____ is a payment determination report sent by an insurance carrier electronically.
Paper insurance claim forms will produce a _.
ERA/EOB
You are a PAR provider and your patient has an 80/20 plan. You bill $1,200 to the insurance company. The insurance company has sent an EOB stating that the allowed amount is $800. How much must the office write-off?
$400
Adult children covered under a patient's policy may continue being covered under the parent's medical insurance policy up to the age of
26
What codes are used to include specified conditions that cannot be classified with any other code?
NEC
The percentage that shows the effectiveness of collection methods is called the
collection ratio
What document shows the professional services rendered to the patient, the charge for each service, payments made, and the balance owed?
patient statment
A claim form without errors is known as what type of claim?
clean
______is a service that collects, corrects, and transmits electronic insurance claims.
clearinghouse
How often are diagnostic and procedure codes updated?
every year
If no payment has been made after the collection process and all procedures have exhuasted what happens to the debt?
uncollectable amount/bad debt is written off
Payment system used by Medicare is the _.
resource-based relative value scale
An appointment was scheduled for a new patient, who asked how much the fee would be for the visit. What should the administrative medical assistant do?
Provide an estimate of the exam AND explain that the estimate is prior to other services, such as blood work.