Exam 19: Electronic Medical Claims Processing

When creating insurance claims using the medical practice management software, the medical office specialist should: A)print out paper claims to check for accuracy. B)print out a detailed report to check for accuracy. C)perform a detailed audit to check for accuracy. D)review the information onscreen to check for accuracy.

To review a list of outstanding patient accounts, the medical office specialist will refer to: A)aging reports. B)general ledgers. C)encounter forms. D)billed claims.

The patient's employment information would be found on the: A)registration form. B)Explanation of Benefits (EOB). C)encounter form. D)Patient Day Sheet.

Payment posting is considered a(n) __________ function in a medical office or hospital.

To accurately post payments, the medical office specialist must be familiar with insurance carriers' and other payers': A)financial health and industry rating. B)contracts, procedures, and Explanation of Benefits (EOB) formats. C)address, phone number, and e-mail address. D)managers, administrators, and local representatives.

Remarks by the insurance carrier explaining denials, pended claims, or adjustments in payment amounts can be found on the: A)registration form. B)Explanation of Benefits (EOB) C)encounter form. D)claim summary.

What should the medical office specialist do if the patient is NOT the guarantor?

The medical office specialist will be responsible for entering all patient demographic information and posting all charges, payments, and adjustments.

Details about a patient's deductible and coinsurance amounts can be found on the patient registration form.

A list of modifiers commonly used with procedure codes can be found on the: A)registration form. B)Explanation of Benefits (EOB). C)encounter form. D)Patient Day Sheet.

If a patient was seen by the physician and will need a follow-up appointment, the physician will indicate this on the encounter form.

Patient insurance information that must be entered into the medical practice management system can be found on the: A)registration form. B)Explanation of Benefits (EOB). C)provider claim form. D)Patient Day Sheet.

What is involved in payment posting in a medical office?

After setting up the provider, if necessary, the first step in entering information into the medical practice management software is to: A)enter the insurance carrier. B)enter the charges. C)enter the EOB. D)enter new patients to the patient list.

A record of the patient's financial transactions for the encounter is called a(n): A)EOB. B)superbill. C)walkout receipt. D)batch report.

When batching out, patient payments such as copayments and deductibles should be added to EOB payments from insurance companies.

A listing of billed services NOT covered by insurance can be found on the: A)registration form. B)Explanation of Benefits (EOB). C)encounter form. D)Patient Day Sheet.

In accounts receivable terminology, posting refers to: A)subtracting payments made on an account. B)making an adjustment on an account. C)entering a financial transaction into a computer system. D)making sure all accounts balance at the end of the day.

The patient on an account: A)is always the guarantor. B)is always the subscriber. C)does not have to be the guarantor but must be the subscriber. D)does not have to be the guarantor or the subscriber.

The specific location or block on a computer screen into which data must be entered is called a(n) __________ .