Billing, Coding, and Insurance practice questions

Answer: A) Mail the patient a final written notice giving the date the account will be referred if it is not paid

Before an account goes to collections, the practice should send a final written notice with a firm deadline, as its collection policy requires. It should not tell third parties about the debt or abruptly end the patient's care.

• ACorrect. A final notice that sets a deadline gives the patient one last chance to pay or arrange a payment plan. It also documents that the practice followed its collection policy before referral.
• BIncorrect. An emergency contact is for emergencies, not billing. Telling a third party about the patient's account discloses protected information without authorization.
• CIncorrect. Leaving details of services and balances where coworkers might hear them is an improper disclosure. Collection messages should be discreet and kept to the minimum necessary.
• DIncorrect. Ending care with no notice period can count as patient abandonment. Discharging a patient is a separate process that requires reasonable advance notice.

Answer: A) At check-in, at the time of service

A copayment is a fixed amount the plan sets for a covered service, so the patient normally pays it at the time of the visit. Amounts that depend on how the claim is processed, like coinsurance, are billed after the remittance comes back.

• ACorrect. A copayment is a fixed amount set by the plan, so it is known in advance and is normally collected when the patient is seen. This also helps the office's cash flow.
• BIncorrect. Waiting for the remittance advice makes sense for amounts that are not known in advance, such as coinsurance or deductible balances. A fixed copay is already known at the visit.
• CIncorrect. Billing a known copay later on a statement delays payment and raises collection costs. Copays are collected at the visit.
• DIncorrect. The copay is the patient's share of a covered service, so it is owed whether or not the claim is denied. A denial would make the patient responsible for more than the copay.

Answer: D) Medicare Part C coverage offered by private insurance companies that work with Medicare

Medicare Advantage is Medicare Part C. Private insurers that work with Medicare offer these plans, which bundle hospital, medical, and often drug coverage. It is different from TRICARE, Medicaid, and stand-alone Part D plans.

• AIncorrect. This describes TRICARE, the military health program, not Medicare Advantage.
• BIncorrect. This describes Medicaid. Medicare Advantage is part of Medicare.
• CIncorrect. This describes a stand-alone Medicare Part D plan. Medicare Advantage provides Part A and Part B benefits and often includes drug coverage too.
• DCorrect. Medicare Advantage (Part C) plans are run by private insurance companies that work with Medicare. They provide Part A and Part B benefits and often Part D drug coverage.

Answer: B) Matching the office's records with the bank statement

• AIncorrect. That's paying bills.
• BCorrect. It catches errors.
• CIncorrect. That's billing.
• DIncorrect. That's records destruction.

Answer: C) The patient

• AIncorrect. The patient gets the EOB.
• BIncorrect. The provider gets an RA.
• CCorrect. The provider gets a remittance advice.
• DIncorrect. The patient gets the EOB.

Answer: A) A claim the payer can process without asking the provider or a third party for more information

A clean claim is complete and error-free, so the payer can process it without asking the provider or a third party for more information. This speeds up payment.

• ACorrect. Federal Medicaid rules define a clean claim as one that can be processed without obtaining additional information from the provider or a third party. Clean claims avoid delays caused by requests for more information.
• BIncorrect. "Clean" describes how complete and accurate the claim is when it is submitted, not whether it has been paid or whether the patient owes anything.
• CIncorrect. An electronic claim can still have errors or missing information. How a claim is sent does not make it clean.
• DIncorrect. A denied claim that is corrected and resubmitted is a resubmission or appeal. Being denied first does not define a clean claim, which should be processable when it is first submitted.

Answer: A) Certain veterans' families

• ACorrect. It covers eligible dependents and survivors of certain veterans.
• BIncorrect. They use TRICARE.
• CIncorrect. They use FEHB.
• DIncorrect. That is Medicaid.

Answer: B) Show a service was altered

• AIncorrect. Diagnoses use ICD-10-CM.
• BCorrect. Modifiers explain that a service was changed without changing its code.
• CIncorrect. This is demographic data.
• DIncorrect. Fees are set by the fee schedule.

Answer: A) A service may not be covered

• ACorrect. It informs patients they may be responsible for payment.
• BIncorrect. It is only for possibly non-covered services.
• CIncorrect. It is given before the service.
• DIncorrect. This is unrelated.

Answer: B) The two conditions can't be coded together

• AIncorrect. That isn't Excludes1.
• BCorrect. They're mutually exclusive.
• CIncorrect. It's about code pairs.
• DIncorrect. That's CPT.