M.A.A. Final Exam Study Guide

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M.A.A. Final Exam Study Guide Write today's date correctly for a business letter - ✔✔Month Day, Year What is complementary closing & where is it placed in a business letter? - ✔✔Placed two l... ines below the last line of the body of the letter What are notations & where are they placed in a business letter? - ✔✔enclosures and name/initials of other people receiving copies of the letter What letter style has all lines typed flush to the left? - ✔✔full block What is the process that ensures that a document is accurate, clear, complete, free of grammatical errors, organized logically, & written in an appropriate style? - ✔✔Editing When should you use numerals in general writing as opposed to words for numbers? - ✔✔when the number is 11(eleven) or greater What is fast delivery offered by the US Postal Service for a letter going to another state? - ✔✔Express mail What different types of classes of mail are included in Regular Mail? - ✔✔1st,2nd,3rd,4th class priority and express. Which type of mail delivery service requires the postal carrier to obtain a signature when the item is delivered? - ✔✔Certified First step to processing mail - ✔✔Sorting Second step to processing mail - ✔✔Opening Third step to processing mail - ✔✔Recording Fourth step to processing mail - ✔✔Annotating Fifth step to processing mail - ✔✔Distributing What is the authorization for an insurance carrier to pay the physician or practice directly called? - ✔✔Assignment of benefits What is the person whose name the insurance is carried called? - ✔✔Policyholder/ subscriber What would the most likely outcome of a submitted insurance claim with a diagnosis code of a sore throat and a treatment code indicating a cast for a broken leg be? - ✔✔It would be denied as a billing error because the treatment was not medically What type of insurance cover injuries that are caused by the insured or that occurred on the insurer's property? - ✔✔Workers Compensation What type of patients can receive health benefits under Medicaid? Is it an insurance program? - ✔✔Low income or needy. Not a insurance program. What is the amount Medicare pays the physician or health care provider after the annual deductible is met? - ✔✔80% What is a "participating physician" vs. a "non-participating physician"? - ✔✔Participating physician agrees to accept what the insurance company allows/approves. Payment in full- a nonparticipating physician does not What benefits are included under Workers' Compensation? - ✔✔Rehabilitation costs, so the employee can return to work What is an HMO and what are some characteristics of an HMO? - ✔✔Physician enrolling in an HMO are Participating Physician Which insurance plan would be primary if a husband and wife are both employed and have work-sponsored insurance plans that cover each other & their 3 children? - ✔✔Insurance plan of the person whose birthday fall first in the the calendar What is the intended purpose of the ICD-9 coding? - ✔✔To maintain patient's privacy What is the primary condition for which the patient is receiving treatment called? - ✔✔Diagnosis What should we include with CPT codes so we can ensure the highest allowed level of reimbursement? - ✔✔codes and modifiers What type of CPT codes are considered the most important & why? - ✔✔E/M - Evaluation and Management Codes What is the criteria for a "new"patient under CPT? - ✔✔A patient has not been seen in the office for the last 3 years Is it considered fraudulent of you unbundle procedures intentionally to receive more payment than is correct? - ✔✔Yes What type of patient services was the Health Care Common Procedure Coding System (HCPCS) developed for? - ✔✔Medicare Patients What is code linkage? - ✔✔Analysis of the connection between the diagnosis and procedure code on an insurance claim Define fraud - ✔✔A act of deception used to take advantage of another person or entity What is a medical practice compliance plan? How could it show a "good faith" effort to be compliant with coding regulations? - ✔✔It shows good faith to the insurance company because it demonstrates honesty ongoing attempts have been made to find and fix weak areas of compliance Who is responsible for payment of a 16-year old girl who is pregnant and leaves her parents' home to set up household with her boyfriend? - ✔✔The 16 year old girl Who is responsible for payment and for giving consent for he treatment of a 5-year old child of divorced parents? - ✔✔The parent with legal custody What information should be included in an invoice? - ✔✔The balance from the previous month and an itemized list of charges What is a super bill? - ✔✔An invoice for payment includes charges rendered each day and all info for submitting an insurance claim What is cycle billing? - ✔✔A common system that bills patients once a month that spreads the work of billing over the whole month At how many days past due is a statement generally sent to the patient? - ✔✔30 days At how many days past due would you send a letter saying," Every courtesy has been extended to you in arranging for a payment for your long overdue account. Unless we hear from you by (date), the account will be given to (name of collection agency) for collection." - ✔✔120 days When is it best to send a collection letter that says, "Please let us know when you plan to pay the $250 past-due balance. We have sent you three monthly reminders. If you cannot pay in full now, please call our office to make financial arrangements. We want to be understanding,but need your cooperation"? - ✔✔90 days What is age analysis? - ✔✔The process of clarifying and reviewing past due account from the first date of billing What Act prevents creditors from discriminating against applicants on the basis of age, sex, race, religion, marital status, or income? - ✔✔Equal Credit Opportunity Act List the guidelines established by the Fair Debt Collection Practices Act of 1977 for sending letters and making calls requesting payments for patients? - ✔✔You can not call the patient before 8 am or after 9 pm What info should a medical assistant provide to a collection agency regarding a patient when turning an account over to an agency? - ✔✔The date the last payment or charge was posted to the account What should you do if you make an error when completing a check? - ✔✔Write 'VOID' in ink,across the front of the check & file in numerical order with the return checks What are voucher checks? - ✔✔Business check with the stubs attached What kind of check is a standard check that the bank verifies and sets aside funds to guarantee payment? - ✔✔Certified check What kind of check is purchased from a bank,written on the bank's own checking account, and signed by a bank official? - ✔✔Cashier's check What kind of purchase are usually made from money in petty cash fund? - ✔✔Postage due fees, holiday decorations, staff lunches What type of statement demonstrates the practice's profitability by illustrating the practice's total income and expenses? - ✔✔Statement of income and expense What is financial summary is used by the physician periodically to make sure that the office books balance? - ✔✔Trail Balance List banking tasks that might be used in the medical office - ✔✔Writing checks,accepting checks, endorsing checks HMO - ✔✔Health Maintenance Organization. Restricts patient's to seeing doctors within the plan. Has a primary care physician. PPO - ✔✔Preferred Provider Organization. Patient's have freedom to see any doctor they choose, They pay a higher amount if they see doctors who are not a preferred provider. No primary care physician. Do no required referred to see another physician. Has a yearly deductible. Has a co-insurance rather than a copay. [Show More]

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