Review for Exam 4

Medical Office Administration:

Medical Office Administration Review for Exam 4 ~ Chapters 13 through 16

What does the Hill-Burton Act have to do with providing care for the poor?:

What does the Hill-Burton Act have to do with providing care for the poor? Hospitals built with Federal Hill-Burton funds are required by law to provide indigent care for their communities

What is “Aging an Account?”:

What is “Aging an Account?” It’s a statement breakdown of ‘days overdue’ so that level of delinquency can be dealt with in an appropriate manner

Patient is unstable, acutely ill, needs constant bedside attention:

Patient is unstable, acutely ill, needs constant bedside attention Concurrent care Critical care Emergency care

When the payee signs name on the back of the check:

When the payee signs name on the back of the check Blank endorsement Restrictive endorsement Full endorsement

Regarding lending, what must be disclosed prior to service?:

Regarding lending, what must be disclosed prior to service? All costs, and any interest or late fees that might accrue

If credit is extended to one patient, it must be extended to _________who request it:

If credit is extended to one patient, it must be extended to _________who request it All

Some reasons a bank statement won’t reconcile might be::

Some reasons a bank statement won’t reconcile might be: Forgot to journal a check written Forgot to journal a deposit Incorrect amount was recorded in journal Math errors

The one who receives the money:

The one who receives the money Drawer Drawee Payee

Why would there be “exclusions” on an insurance policy?:

Why would there be “exclusions” on an insurance policy? Pre-existing conditions might be excluded Often there is an exclusion if the patient harms himself or contributes to his own injuries

If patient has both Medicare and Medicaid, which one is “primary?”:

If patient has both Medicare and Medicaid, which one is “primary?” Medicare is primary

It’s the form used to file claims for Medicare and TRICARE:

It’s the form used to file claims for Medicare and TRICARE CMS-1500

It’s seeking the insurance company’s input on how much they will pay for a service:

It’s seeking the insurance company’s input on how much they will pay for a service Pre-certification Pre-determination Pre-authorization

“for deposit only” is:

“for deposit only” is Blank endorsement Restrictive endorsement Full endorsement

The bank where the money is deposited:

The bank where the money is deposited Drawer Drawee Payee

In the following list, they are the two fraudulant activities::

In the following list, they are the two fraudulant activities: Downcoding Upcoding Bundling codes Unbundling codes

Physician fee schedules are based on::

Physician fee schedules are based on: Specialty Education Experience Geographic region Overhead costs

Is it okay for an office to charge a patient for phone calls?:

Is it okay for an office to charge a patient for phone calls? Yes, if it is a phone call to the patient or to a consulting physician about the patient

The one who orders the bank to pay:

The one who orders the bank to pay Drawer Drawee Payee

It’s a patient who has been seen in the past three years:

It’s a patient who has been seen in the past three years New patient Established patient Consultation

Prevents serious injury or dysfunction to a body or organ:

Prevents serious injury or dysfunction to a body or organ Concurrent care Critical care Emergency care

If the check is made out to John, who signs the back and gives it to Fred, and then Fred signs the back and cashes it…:

If the check is made out to John, who signs the back and gives it to Fred, and then Fred signs the back and cashes it… Blank endorsement Restrictive endorsement Full endorsement

It’s the insurance company evaluating whether or not a service is medically necessary (and therefore will it be covered..):

It’s the insurance company evaluating whether or not a service is medically necessary (and therefore will it be covered..) Pre-certification Pre-determination Pre-authorization

Who is the “insured?”:

Who is the “insured?” The one who pays premiums for the insurance; may or may not be the patient

What’s the difference between a change drawer and petty cash?:

What’s the difference between a change drawer and petty cash? Change drawer is used to make change for patients who pay co-pays in cash Petty cash drawer is used to make small purchases for the office BOTH require an accounting of receipts, and reconciliation at the end of the day

Who are “dependents?”:

Who are “dependents?” People covered under the insured’s policy – usually spouse and children

What is a “Claim?”:

What is a “Claim?” It’s a request for payment from an insurance company

Who is the gatekeeper?:

Who is the gatekeeper? The gatekeeper is a primary care doctor who oversees all of the patient’s care (to control costs and ensure all tests, procedures, etc., are reasonable) A PCP is called a gatekeeper (usually) in managed care

Discussion with patient or family regarding diagnosis, prognosis, or compliance, etc.:

Discussion with patient or family regarding diagnosis, prognosis, or compliance, etc. Counseling Consultation Referral

What does it mean to be paid by capitation?:

What does it mean to be paid by capitation? Capitation is a flat pre-paid fee per head, paid to the doctor by the insurance company regardless of how often the patient is seen Managed care uses this method of payment to discourage over-prescribing treatments and to manage costs

It’s seeking the insurance company’s input on whether or not a service is “covered”:

It’s seeking the insurance company’s input on whether or not a service is “covered” Pre-certification Pre-determination Pre-authorization

Second opinion:

Second opinion Counseling Consultation Referral

It’s a patient who has not been seen in the past three years:

It’s a patient who has not been seen in the past three years New patient Established patient Consultation

It’s when you break down one code into multiple codes so you can get back more money…it’s illegal:

It’s when you break down one code into multiple codes so you can get back more money…it’s illegal Unbundling

Similar services provided to the patient by multiple providers:

Similar services provided to the patient by multiple providers Concurrent care Critical care Emergency care

A primary codebook used for procedures is:

A primary codebook used for procedures is CPT

The two forms a patient must sign for insurance claims are::

The two forms a patient must sign for insurance claims are: Assignment of benefits – so the doctor can get paid directly from the insurance company Consent – so the doctor can release PHI to the insurance company

Transfer of a particular care to another physician:

Transfer of a particular care to another physician Counseling Consultation Referral

When a submitted code is changed to a lower level code:

When a submitted code is changed to a lower level code Downcoding

When a physician bills for a higher level of care than was actually provided – it’s illegal:

When a physician bills for a higher level of care than was actually provided – it’s illegal Upcoding

It covers illness or injury on the job:

It covers illness or injury on the job Worker’s compensation Disability types? Nondisability ~ patient may still be able to work even while seeing the doctor Temporary disability ~ patient may not be able to do all the functions of his job for a limited time Permanent disability ~ after all is said and done, patient is left with some residual disability

What is a limiting charge?:

What is a limiting charge? The maximum amount a non-participating physician can charge a Medicare patient

Can a physician bill a patient who didn’t show up for an appointment?:

Can a physician bill a patient who didn’t show up for an appointment? Yes!

Is it legal to have separate fee schedules depending on the type of payment?:

Is it legal to have separate fee schedules depending on the type of payment? Yes! In fact, separate fee schedules can be maintained for: Medicare Managed Care Private Pay Worker’s Compensation cases…

What is a Superbill?:

What is a Superbill ? It’s a multipurpose billing form which includes insurance information, procedure and diagnosis codes It can be used as a payment receipt, an office routing document, and an insurance claims form

What are the advantages of cycle billing?:

What are the advantages of cycle billing? Since billing is staggered throughout the month instead of being all prepared on one day of the month…. The workload to prepare billing is spread out over time The income generated from the billing comes in over time

What’s a Dun message?:

What’s a Dun message? It’s a payment reminder usually printed in the statement sent to the patient

Fair Debt Collection practices include::

Fair Debt Collection practices include: No calling on Sunday No calling before 8:00 a.m. or after 9:00 p.m. No more than one call per day And many others…page 431

Three important rules to remember if you send a patient account to Collections::

Three important rules to remember if you send a patient account to Collections: No more contacting the patient Cannot ever file a Small Claims against the patient Doctor must still send a discharge letter to officially discharge patient from the practice

Can you collect from a patient going through bankruptcy?:

Can you collect from a patient going through bankruptcy? Yes, but you must file a claim for what’s owed with the lawyer (or whoever is processing the bankruptcy)…and then you might get paid some, all, or none of what’s owed You can NOT continue to bill the patient

How should collection letters be sent?:

How should collection letters be sent? Certified mail with return receipt requested

With which accounting method is it easier to catch errors? :

With which accounting method is it easier to catch errors? Single-entry accounting Double-entry accounting Why? Because it must balance and NON-balances appear right away showing an error must have been made

If the patient has insurance through employer and Medicare, which one is primary insurance?:

If the patient has insurance through employer and Medicare, which one is primary insurance? Insurance through employer is primary

What are some insurance programs which cover military personnel? :

What are some insurance programs which cover military personnel? TRICARE covers active military personnel and their families CHAMPVA covers veterans and their dependents

What’s the “donut hole?”:

What’s the “donut hole?” It’s a gap in Medicare Part D prescription coverage The patient pays 100% of prescriptions after $2000 of drug costs has accumulated but before the patient has paid $3600 out of pocket….within the year.

Is Medicaid insurance? :

Is Medicaid insurance? No. It’s actually an assistance program for the poor.

What does it mean for the doctor to “accept assignment?”:

What does it mean for the doctor to “accept assignment?” It means he agrees to the payment terms of the carrier (i.e. Medicare will pay him 80% of fee schedule).

Who is eligible for Medicare?:

Who is eligible for Medicare? People age 65, blind, disabled, with chronic or end-stage kidney disease and a few others..

What are some methods Medicare uses to contain costs?:

What are some methods Medicare uses to contain costs? Peer review organizations to evaluate medical necessity Civil monetary penalties law to prevent fraud Stark I and II to prevent kickbacks for doctor referrals to their own businesses Deficit Reduction Act has incentives for doctors to accept Medicare assignment Tax Equity and Fiscal Responsibility Act uses DRG’s to assess reasonableness of hospital fees

It’s the primary book for diagnosis codes:

It’s the primary book for diagnosis codes ICD-10-CM

What is a code modifier? :

What is a code modifier? It’s a number or letter combo used with a procedure code to indicate some difference in description…like the procedure took longer than usual, or required unusual anesthesia, or some other variation to the procedure code

What is “professional courtesy?”:

What is “professional courtesy?” It’s free service or discounted service for other physicians or their families Not really done today because most have insurance (and could actually be illegal if no one was charged and yet insurance claim was filed..)

Is it a problem if the patient writes “Paid in Full” on their statement or check? :

Is it a problem if the patient writes “Paid in Full” on their statement or check? It can be a problem if they are not, in fact, Paid in Full. By cashing this check unconditionally, you are accepting that the account is paid in full. You can either return the check or cash it with a “conditional endorsement.”

What is an ABA number?:

What is an ABA number? It’s an American Banking Association number; a fraction-like number on checks used to identify the bank The ABA number if often used on bank deposit slips when many checks must be itemized

What is a Daysheet?:

What is a Daysheet ? It’s a cumulative list of the daily activities in the medical office Including… Patients seen that day Services rendered Fees charged Payments received in person or by mail Any calculated adjustments

What is “coordination of benefits?”:

What is “coordination of benefits?” Coordinating benefits prevents duplication of services It is accomplished by filing with the “primary insurance carrier” first, and after receiving confirmation/payment, filing with the “secondary insurance carrier.”

If the books don’t balance, what are some common causes for the mistake?:

If the books don’t balance, what are some common causes for the mistake? Missing a transaction entirely and not writing in a figure A number placed in the wrong debit/credit column A transposed number – 360 instead of 306 A sliding number – 1500 instead of 15.00 And many others…

What is a “carrier?”:

What is a “carrier?” The insurance company paying the benefit