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Exam 19: Electronic Medical Claims Processing

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Question 31

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The medical office specialist should enter ICD-9 codes obtained from the: A)patient history. B)doctor's dictation. C)encounter form (superbill). D)progress notes.

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encounter ...

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Question 32

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When total charges, payments, and adjustments do NOT match the totals shown on the day sheet report, the medical office specialist must go through the report, encounter forms, and Explanation of Benefits forms (EOBs) patient by patient to find the discrepancy.

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Question 33

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If your MPM does not automatically save, how often should you manually save data? A)At the end of the day B)Once per hour C)After each patient D)After batching out and before creating claims

The patient's marital status information would be found on the: A)registration form. B)Explanation of Benefits (EOB). C)encounter form. D)Patient Day Sheet.

Charges posted to an account are assigned based on the ICD-9 code describing the patient's condition.

Patient demographic and insurance information can be found on the: A)registration form. B)Explanation of Benefits (EOB). C)provider claim form. D)Patient Day Sheet.

The provider's recommendation for when the next appointment should be scheduled can be found on the: A)registration form. B)Explanation of Benefits (EOB). C)encounter form. D)Patient Day Sheet.

If a medical office specialist were to bill for a new patient office visit, the CPT code would be found on the: A)registration form. B)Explanation of Benefits (EOB). C)encounter form. D)ledger sheet.

Details about adjustments in payment amounts made by the insurance carrier are reported on the Explanation of Benefits (EOB).

The default provider identification number is the federal __________ number.

When entering a patient's insurance information into the system, it should be recorded exactly as it appears on the patient's insurance ID card.

To post charges to an account, the medical office specialist refers to the __________ to obtain ICD-9 and CPT codes for the services provided.

Three documents used to enter data in the simulation as well as in a medical office are __________ __________ and __________

When the medical office specialist stops entering data for the day and generates and reviews reports to make sure that all accounts balance, the process is referred to as: A)accounting. B)batching out. C)balancing out. D)reporting.

The patient's emergency contact information can be found on the: A)registration form. B)Explanation of Benefits (EOB) form. C)provider claim form. D)Patient Day Sheet.

What should the medical office specialist do if the Patient Day Sheet does NOT balance?

The subscriber on an account: A)is also the guarantor. B)is also the patient. C)can be the guarantor and the patient. D)can be the guarantor but not the patient.

If a physician refers the patient for lab work, he or she would indicate the order on the: A)registration form. B)encounter form. C)Explanation of Benefits (EOB). D)preauthorization form.

Payments reflected on the Patient Day Sheet should equal the negative amount on the Total Receipts line of the report.

Any adjustments in amounts based on the insurance contract terms can be found on the: A)registration form. B)Explanation of Benefits (EOB). C)encounter form. D)claim form.