- Define the following
| a | bulk payment | |
| b | carrier | |
| c | chart note | |
| d | copayment | |
| e | deductible | |
| f | guarantor | |
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Answer 1 (a) Insurance payments which cover more than 1 patient in the draft, (b) the insurance company (c) the note relating to a visit describing the problem and the treatment, (d) the amount due from the beneficiary, (e) the amount the insurance company will not pay annually – most times due from the guarantor, sometimes paid by a secondary insurance company (f) the bottom-line personal responsible to pay any portion of an unpaid bill
2. Why is it important to make sure the patient signs an Assignment?
____________________________________________________________
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Answer 2 To make sure the provider gets the insurance payment
3. Under the birthday rule, which insurance company gets billed first _________________
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Answer 3 Whichever spouse’s birthday falls first in a calendar year
- Why is chart documentation so important to the billing process ____________________________________________________________
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Answer 4. It substantiates and documents the services provided
- Two types of primary codes are used for billing. They are
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Answer 5. CPT and ICD
- Describe which code in #5 is used for what
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Answer 6. CPT – professional procedures, ICD – diagnoses
- After Medicaid pays, what percentage is billed to the guarantor ___________________
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Answer 7. 0% – whatever Medicaid pays is considered payment in full
- What is the deductible amount designed to do ____________________________________________________________
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Answer 8. Make patients more responsible for the amount of and cost for medical care
- What is a contract provider ________________________________________________
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Answer 9. A provider who is contracted for some performance level, and agrees to accept some specific payment relating to same
10. Can one bill and/or collect from the patient on the same day the service is provided under Medicare rules Y / N Why or why not_______________________________
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Answer 10. No, Medicare must be billed first so the amount due from the patient is not calculated until the process is complete
11. What are dependents ______________________________________
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Answer 11. Patients for whom the guarantor is responsible
12. What is an EOB __________________________________________
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Answer 12. Explanation of Benefits
13. Under a subrogated claim, the provider agrees to wait for payment until the
__________________________________________________________
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Answer 13 Whole process is completed
- What is an encounter ______________________________________
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Answer 14 The visit between the patient and the provider
- What is an EIN # _________________________________________
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Answer 15 Employee Identification Number (assigned by the Federal government)
- Name three types of medical notes one might find in a chart
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Answer 16 Visit chart note, operative note, discharge summary, lab report, x-ray report, etc.
17. Is the patient the same party as the guarantor Y / N
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Answer 17 No, not necessarily – the person responsible for the patient’s portion of any bill