What are collection agency fees based on? Right Ans - A percentage of
dollars collected
Self-funded benefit plans may choose to coordinate benefits using the gender
rule or what other rule? Right Ans - Birthday
In what type of payment methodology is a lump sum or bundled payment
negotiated between the payer and some or all providers? Right Ans - Case
rates
What customer service improvements might improve the patient accounts
department? Right Ans - Holding staff accountable for customer service
during performance reviews
What is an ABN (Advance Beneficiary Notice of Non-coverage) required to do?
Right Ans - Inform a Medicare beneficiary that Medicare may not pay for the
order or service
What type of account adjustment results from the patient's unwillingness to
pay for a self-pay balance? Right Ans - Bad debt adjustment
What is the initial hospice benefit? Right Ans - Two 90-day periods and an
unlimited number of subsequent periods
When does a hospital add ambulance charges to the Medicare inpatient claim?
Right Ans - If the patient requires ambulance transportation to a skilled
nursing facility
How should a provider resolve a late-charge credit posted after an account is
billed? Right Ans - Post a late-charge adjustment to the account
an increase in the dollars aged greater than 90 days from date of service
indicate what about accounts Right Ans - They are not being processed in a
timely manner
, What is an advantage of a preregistration program? Right Ans - It reduces
processing times at the time of service
What are the two statutory exclusions from hospice coverage? Right Ans -
Medically unnecessary services and custodial care
What core financial activities are resolved within patient access? Right Ans
- Scheduling, insurance verification, discharge processing, and payment of
point-of-service receipts
What statement applies to the scheduled outpatient? Right Ans - The
services do not involve an overnight stay
How is a mis-posted contractual allowance resolved? Right Ans -
Comparing the contract reimbursement rates with the contract on the
admittance advice to identify the correct amount
What type of patient status is used to evaluate the patient's need for inpatient
care? Right Ans - Observation
Coverage rules for Medicare beneficiaries receiving skilled nursing care
require that the beneficiary has received what? Right Ans - Medically
necessary inpatient hospital services for at least 3 consecutive days before the
skilled nursing care admission
When is the word "SAME" entered on the CMS 1500 billing form in Field 0$?
Right Ans - When the patient is the insured
What are non-emergency patients who come for service without prior
notification to the provider called? Right Ans - Unscheduled patients
If the insurance verification response reports that a subscriber has a single
policy, what is the status of the subscriber's spouse? Right Ans - Neither
enrolled not entitled to benefits
Regulation Z of the Consumer Credit Protection Act, also known as the Truth
in Lending Act, establishes what? Right Ans - Disclosure rules for consumer
credit sales and consumer loans
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