Exam 19: Electronic Medical Claims Processing

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Medical practice management software typically contains a menu of CPT and ICD-9-CM codes.

(True/False)
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After patient demographic, insurance, and encounter-form information has been entered for an office visit, the next step is to create and submit the insurance claim.

(True/False)
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The patient's relationship to the subscriber can be: A)self. B)child. C)spouse. D)any of the above.

(Short Answer)
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The medical office specialist will post insurance payments and adjustments from: A)superbills (encounter forms). B)credit card receipts. C)explanation of benefits (EOB) forms. D)bank deposit slips.

(Short Answer)
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If the amounts totaled from superbills and Explanation of Benefits forms (EOBs) do NOT match the report totals, the medical office specialist should: A)review the report, superbills, and EOBs patient by patient to locate any errors. B)submit the report to a supervisor with a memo stating the problem. C)call the computer system repair person to check the program. D)go home and address the problem the next day with a fresh outlook.

(Short Answer)
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Patient demographic information such as date of birth and address can be found on the patient registration form.

(True/False)
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The name of the physician rendering care to a patient on a specific day would be found on the: A)registration form. B)Patient Day Sheet. C)ledger sheet. D)encounter form.

(Short Answer)
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The medical office specialist should refer to the Explanation of Benefits (EOB) to make sure all transactions balance each day.

(True/False)
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Detailed information about the subscriber on the insurance plan that will be billed would be found on the: A)registration form. B)Explanation of Benefits (EOB). C)encounter form. D)ledger sheet.

(Short Answer)
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What are four of the key elements on the patient registration form?

(Essay)
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A detailed accounting of charges that are the patient's responsibility can be found on the: A)registration form. B)Explanation of Benefits (EOB). C)encounter form. D)Patient Day Sheet.

(Short Answer)
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The patient is always the same as the subscriber on an account.

(True/False)
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Patients will provide their demographic information on the patient __________ form.

(Short Answer)
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If a physician has referred the patient to the provider, the physician's name will be listed on the: A)registration form. B)Explanation of Benefits (EOB). C)encounter form. D)Patient Day Sheet.

(Short Answer)
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Match the following:
The form sent by the insurance company detailing claim status, payments, adjustments, and amounts due from the patient
CPT
Posted charge, payment, or adjustment
subscriber
Individual who receives services from the provider
medical practice management (MPM)
Correct Answer:
Verified
Premises:
Responses:
The form sent by the insurance company detailing claim status, payments, adjustments, and amounts due from the patient
CPT
Posted charge, payment, or adjustment
subscriber
Individual who receives services from the provider
medical practice management (MPM)
Codes used to report services rendered to the patient
transaction
Monies received for services rendered
patient
Software used as a patient database and for posting financial transactions in a medical office or healthcare facility
Explanation of Benefits (EOB)
Codes used to indicate the physician’s diagnosis or impression of the patient’s condition
encounter form
Individual who has purchased the health insurance policy
registration form
The form the physician uses to document services provided to a patient
ICD-9-CM
The form used to document a patient’s demographic and insurance information
payment
(Matching)
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What is an encounter form?

(Essay)
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Payment posting includes posting all of the following EXCEPT: A)payments to suppliers. B)insurance payments. C)patient payments. D)contractual adjustments.

(Short Answer)
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When posting charges to a patient account, the medical office specialist should obtain the CPT code(s) from the: A)patient history. B)doctor's dictation. C)encounter form (superbill). D)progress notes.

(Short Answer)
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The subscriber on an account is the person responsible for paying the bills.

(True/False)
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Medical practice management software allows the user to: A)submit claims electronically. B)print paper claims. C)check claim data onscreen. D)all of the above.

(Short Answer)
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