Training Review #1

EOB Terminology

100

Amount one pays before their insurance plan starts to pay

Deductible

200

Time frame given by the insurance companies to the providers within which they must submit their claims. This is calculated from the date of service (DOS)

Timely Filing Limit (TFL)

300

Amount the payer has decided to reimburse the provider, based on the allowed amount. 

Paid Amount

400

What are the Patient Responsibility codes as seen on an EOB? 

Deductible(PR1), Co-insurance(PR2), Co-Payment(P3)

500

Explain the calculation for a contractual adjustment

Billed amount - allowed amount = contractual adjustment

Healthcare Providers

100

Subscriber, member, dependent, policy holder, enrollee, beneficiary

Patient

200

Doctors, hospitals, hospice, rehab centers, Pharmacy, home healthcare, PA, RN, Specialist

Provider

300

Insurance Company / Carrier 

Payer

400

T/F: A registered nurse can prescribe medication

False 

500

List all the types of health insurance plans (Hint: 9 types)

HMO, PPO, POS, Indemnity, HRA, HSA, High Deductible Health Plan, Catastrophic Health Insurance, and Exclusive Provider Organization (EPO) 

Insurance Types

100

This is a medical benefit program instituted for the uniformed service personnel 

Tricare 

200

What are the (3) categories of Insurances 

Federal, Liability, and Commercial 

300

This provides members with medical care services through a network of providers who agree to supply services to members 

Health Maintenance Organization (HMO)

400

If the patient has Medicare and Tri-Care for Life, which insurance will be primary? 

Medicare

500

This is a Medicare replacement/advantage/ managed - care plan that includes Part A and Part B additional benefits. 

Part C 

Patient Life Cycle

100

How many steps are in the Patient Life Cycle?

10

200

Here at IKS, we are responsible for which parts of the Patient Life Cycle? 

Billing, Payment Posting, Account Receivable, and Patient AR

300

What are necessary pieces of documentation when it comes to Front End Registration? 

Assignment of Benefits(AOB), Release of Information(ROI)/Consent/HIPAA, and Advanced Beneficiary Notice(ABN)/ Waver of Liability(WL)

400

What are the (6) Appointment Types 

New Patient visit, Post Op, Follow Up, Annual Wellness Visit (AWV), Established Visit, Vaccination

500

List the correct order of the Patient Life Cycle 

 Appointment Scheduling, Insurance Verification, Front End Registration, Encounter, Documentation in EHR, Coding & Charge Capture, Billing, Payment Posting, Accounts Receivable, and Patient AR 

CSR/PAR SOP

100

What is the Tax ID for ProHealth Urgent Care? 

46-1883579

200

What are the requirements for Payment Plans? 

No less than $50/month; cannot exceed 12 months 

300

T/F: To be eligible for Payoff discount the patient must receive at least one statement and pay a partial payment on the same day the discount is offered

False 

400

What (2) pieces of PHI have to be validated in the opening of your call?

Patient Date of Birth(DOB) and full mailing address including the city, state, and zip code

500

What should you do if a patient needs to void a same day Payment?

1) Send email to: [e-mail] including Patient's full name, amount paid, last 4 digits of card number,  day of payment, patient's account number, how/where the patient was made 

2) Notify supervisor

3) Notify the patient they can perform the activity via self service in mychart