1. It is important to make the patient aware of the mailing address, interest rates, and length of agreement when setting up a A. fee schedule. B. payment arrangement. C. pre-payment plan. D. deductible fee. - CORRECT ANSWER payment arrangement. —-Rationale—- A payment arrangement is an agreement between the patient and medical office to make monthly payments on a balance that is the patient's responsibility. All the information will be on the agreement that the patient signs. A fee schedule is a list of the established charges for the physician office services. A pre-payment plan a way for a patient to pay for services in advance. The deductible is what is required by the insurance company and is the patient's responsibility to pay. Which of the following is the correct term for a doctor who enters into an agreement with a third party payer on charges, discounts, and services rendered to their policyholders within the network? A. MAC B. PAR C. LOA D. PPO - CORRECT ANSWER PAR —Rationale— A PAR (participating) provider is a physician who enters into an agreement with a payer to offer discounts on charges rendered to their policy holders. Which of the following should a practice's financial policy always explain? A. what is required from the patient and when payment is due B. what payment options the patient has available C. the practice's fee for service charge master D. the insurance carriers the practice is contracted with - CORRECT ANSWER what is required from the patient and when payment is due —Rationale— The practice's financial policies should always be explained to the patient. The patient should always be aware of what is required from them and when payments are due. A patient had a procedure which was billed at $200.00. The allowed amount was $150.00 and he has $50.00 left to meet of his deductible. His co-insurance is 20%. How much does the patient owe? A. $90.00 B. $80.00 C. $120.00 D. $100.00 - CORRECT ANSWER $80.00 —Rationale— The insurance company's maximum allowed amount is the total amount allowed to be paid to the provider. In this case, it is $150.00. The deductible is a set amount that each patient must meet annually prior to their insurance benefits beginning. In this question the patient still has $50 remaining to their deductible. Coinsurance is cost sharing between the insurance company and the policyholder. After the deductible has been met, the policyholder pays a certain percentage of the bill and the insurance company pays the remaining percentage of allowable charges. The patient in this question is responsible for 20%. $150 allowed amount. 20% of $150 allowed is $30. Patient still owes $50 deductible. Patient would owe $80 total. The physician charges $100 for a visit. The insurer allowable amount is $80. The patient has a $200 deductible, which has not been met. Which of the following will happen? A. The insurer will send an $80 check. B. The patient will be billed $80. C. The insurer will send a $100 check. D. The patient will be billed $100. - CORRECT ANSWER The patient will be billed $80. —Rationale— In this scenario, the patient will be billed $80. The insurance company will not pay anything until the deductible is met. The allowed amount is now the cost of the service, so since the deductible is not met, the patient will be responsible for the entire $80. Which of the following documents from the insurance carrier should the payment poster read and post the payments or contractual adjustments to the patient account? A. Medicare summary notice B. remittance advice C. advance beneficiary notice D. fee schedule - CORRECT ANSWER remittance advice —Rationale— A remittance advice is used to post payments from insurance carriers. It will explain the reasons for payments or denials, the allowable amounts, copayments, patient balances, etc. A Medicare summary notice is sent to Medicare patients and explains their responsibilities, if any. An advance beneficiary notice is a document that is signed by a patient prior to a service that is known to be ineligible for payment for an insurance carrier, the patient agrees to pay for the service in full. A fee schedule is used by a practice and states the charges for services. The insurance and coding specialist received an EOB and is posting the payments to the patient accounts. According to the following information below, how much does the patient still owe for this service? Non-participating provider Copay: $20, paid at time of service Deductible amount that patient paid: $100 Accepted fee for service: $250 Insurance payment: $75 A. $155 B. $175 C. $55 D. $75 - CORRECT ANSWER $55