Practice Review Domain 6- Billing and Revenue Cycle

What does EDI stand for?

• Educational Diagnostic Instrument
• Electronic Diagnostic Instrument
• Electronic Data Interchange
• Elective Data Interface

What does WC stand for?

• Women with Infant Children
• Working Communities
• Well Communities
• Workers’ Compensation

What does CMS stand for?

• Company for Medical Services
• Center for Medicinal Solutions
• County Medical Services
• Centers for Medicare & Medicaid Services

What does EOB stand for?

• Extended Occupational Benefits
• Explanation of Benefits
• Extra Opportunities Beneath
• Extended Operating Beliefs

What does PPO stand for?

• Nothing by mouth
• Preferred Personal Organization
• Pertinent Patient Organization
• Preferred Provider Organization

What is an HMO?

• Health Maintenance Organization
• Homeostatic Medical Organization
• Hospital Medical Organization
• Health Managing Office

The CMS-1500 form is a (an):

• electronic claim

• paper claim

• remittance advice

• explanation of benefits

Which of the following is an example of a co-payment?

• $100 is written off a patient's account due to a contracted rate with the patient's insurance company

• the patient's secondary insurance pays the remaining amount of a bill after the primary insurance has paid

• an insurance company pays 80% of the cost of medical services and the insured pays the other 20%

• a fixed amount of $25 is paid by the patient before she receives service from the provider

The process of collecting delinquent accounts begins with establishing how much is owed and __________________.

• how much the insurance company paid.

• how long the patient has been seen by the provider.

• how long the patient has been insured.

• how long the amount owed has been outstanding.

The clinic manager has asked you, the administrative medical assistant, to prepare a report that details claims or patient accounts that are 90 days past due. What type of report will you run?

• overdue

• aging

• Dunning

• global