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Quarterly PMO Meeting - AR Quiz Bowl! (Table 10) Flashcards | StudBud
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Quarterly PMO Meeting - AR Quiz Bowl! (Table 10)
Quarterly PMO Meeting - AR Quiz Bowl! (Table 10)
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Find out where your strengths and opportunities are to hone your AR skills!
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1
Which is NOT a main component of VOI Simplify?
Verify pt eligibility and insurance information
Fill out a VOI Simplify form and scan it into the doc center
Correct the coverage table as you post checks
Check for the new default #1 coverage table
2
What type of adjustment is a FP Adjustment?
Collections
Production
3
When a patient pays off a collections balance in the office, what do you need to do?
Post payment, call Robin to reverse the collections adj
We cannot accept payment on a collections account in-office
Post payment, call the Collections Team at Support Office
Post payment, reverse adj, & call the collections agency
4
How often should the Payment Agreement Report be worked?
Weekly
Quarterly
Daily
Monthly
5
What type of adjustment is a Misc Credit Adjustment?
Collections
Production
6
An insurance rep gives you a payor ID not in our payor ID drop-down menu. What should you do?
Use the payor ID search on the intranet to verify
Type the payor ID given to you in the payor ID box
Flag the account that claims must be mailed
Change the payor ID to 06126 (all other payors)
7
If our ledger fee is $150, what is the correct adjustment?
$70 misc credit adjustment
$86 insurance adjustment
$70 insurance adjustment
$44 insurance adjustment
8
What is the Thrive value for Over 60 patient aging %?
5%
10%
20%
16%
9
What is Thrive for % Over 90 Patient Aging?
14%
5%
20%
8%
10
A signed financial policy is required to send a patient to collections.
True
False
11
On a patient ledger, you see an insurance adjustment on every claim. What's your first thought?
We are out of network
Somebody can't do math
Treatment plan was not updated
Fee schedule is incorrect
12
When posting the pt's copay, select the provider they saw today and post the payment to them.
True
False
13
Why do we call patients with balances over 30 days?
Because Support Office says so
To increase our chances of collecting the balance
To bond with our patients
Because the PMO said so
14
What happens to an electronic attachment when the payor ID is set to 06126
It is sent electronically to the insurance company
The clearinghouse drops it to paper for us
It has to have an 8-digit date
It is dropped from the claim and never sent
15
For crown week, how do you note the claim we are giving $200 off each crown? (G5 or G6)
Change the ledger fee, then note the claim with the discount
Change the claim format to 2012, then note the claim
Note the claim with "not usual and customary fees"
Send full fees, note the claim the patient received $200 off
16
What is required to check when approving adjustments over $250?
Adjustment for the correct amount
Adjustment to the correct provider
What caused the adjustment was fixed
All of the above
17
Which of the following is one of the 3 AR Reports run nightly?
Claims to Process
All of the Above
Procedures Not Attached to Insurance
Secondary Claims not Created
18
Our MetLife PPO fee is $43. Metlife pays $100 and states they allow $100. What do you do?
Call MetLife to find out why they processed out of network
Post $100 and do a debit adjustment for $57
Stuff this check on the bottom of the pile for someone else
Void the check and send a corrected claim
19
What fee schedule do you attach if a doctor is Delta Premier only?
Office Fee Schedule
No fee schedule
Delta Fee Schedule
Delta Plus Fee Schedule
20
What are the steps in the non-delivered process?
All of the above
Call patient 2 x within 30 days of receipt of appliance
Submit non-delivered request on Request Home Office Support
Send certified letter with follow-up date in 10-15 days
21
What percentage of adjustments can be prevented?
100%
60%
80%
5%
22
Insurance paid less than we expected. Which is NOT a step we need to take next?
Adjust off the remaining unexpected balance
Document why the payment was different
Contact the patient about the balance created
Update the coverage table %
23
What code is posted to the ledger when you post an insurance check & it creates a true credit?
D0098
D0097
ALTLR
ARRVW
24
When we post an ortho insurance payment, why do we need to update benefits used?
To check on any missed handshake payments
So we know we have the correct insurance in the family file
So we know how much insurance owes and what pt balance is
To verify the patient is paying their portion
25
Why is it important to work zero pays before posting checks?
Zero pays self-destruct in 30 days
A zero pay is $$$ that won't be paid unless action is taken
26
What accounts appear on the Over 180 Report
Accounts that have not received a statement in 6 months
Accounts with balances but no activity in over 6 months
Ortho balances over 6 months with periodic ortho visits
Accounts with balances but no activity in over 3 months
27
Where on the Intranet can you find all of the support personnel for your office?
PMO Manual
AR Playbook
Homeroom
Office Directory
28
Which is NOT a reason we change the claim format to 2012 during credentialing?
To charge the patient only the PPO copay
To send the PPO fee only to insurance
To avoid being overpaid
The claim will not process otherwise
29
An e-claims error says Subscriber ID is not found. How do you submit this claim?
Change the ID to the SSN and e-send the claim
Zero out the claim and bill the patient
Change the ID to the SSN and mail the claim
Find the correct ID # or call the pt and then resubmit
30
What type of adjustment is a Payment Debit Adjustment?
Production
Collections
31
You call on a claim & find out a check was sent to another office but NOT cashed. What now?
90 days after issue date, send Robin missing check request
Have the check reissued right away
Ask the insurance company to send a change of address form
Send Robin a missing check request form ASAP
32
When can we take a pre-payment on Care Credit?
If the patient is scheduled within 30 days
If the patient wishes to pre-pay with Care Credit
If the patient only wants one bill from Care Credit
If the patient signs the receipt & we verify identification
33
Can you look up a new patient's insurance benefits using E-Services?
No
Yes
34
When does an office use the adjustment "Write Off/Balance Uncollect"?
Never, only Support Office uses this adjustment
When the patient doesn't have another appointment scheduled
When we write off balances under $10
When we write off balances out of courtesy
35
When reversing a pre-pay, what adjustment do you use to reverse the FP adjustment?
Misc debit adjustment
Misc credit adjustment
You do not reverse the FP adjustment, only the pre-pay
Payment debit adjustment
36
Why do we create a separate ortho insurance plan for an ortho account?
Ortho benefits and max may be different from the regular ins
So we know how many ortho accounts we have in-office
To keep track of insurance plans that have ortho benefits
For tracking purposes
37
What is the most common reason for having to make an insurance adjustment when posting?
Incorrect Fee Schedule
Incorrect Estimated Amount
Incorrect Payor ID
Incorrect Group Number
38
Dr. does a crown on a friend & wants to collect ONLY what ins pays. How do we handle the claim?
We note the claim the patient received a discount
We send a letter to insurance explaining the situation
We tell the patient he will have no copay
We can't charge ins if we don't charge the pt - so no claim!
39
What type of adjustment is a Write-Off/Balance Uncollect Adjustment?
Production
Collections
40
For what reason do we update the coverage table to the new default #1?
Accurate and conservative treatment plans
Fewer statements sent and calls to make
All of the above
The newest ADA codes are added
41
How do you best use the Courtesy Call spreadsheet to diagnose what's missing in your office?
Give it to a BA to work ASAP
Divide the list up and call all accounts
Look at all accounts with balances shown
Look at accounts with balances & no call in the last 30 days
42
We call on all claims over ___________ days old that have not been paid.
120
90
60
30
43
Credentialing states to change the claim format prior to sending claims for Metlife. Why?
So Metlife will pay based on our PPO fee, not on full fee
Because Support Office likes to torment us
So that if Metlife overpays, we know to debit up & keep it
So Metlife knows we are going through credentialing
44
How do you determine if the new default coverage table is attached to a patient's family file?
The code D4346 is split out
Arestin comes up as zero
It says "1" in the coverage table box
The PPO fees will come up in the ledger
45
Why do we post an ortho check as an insurance payment and not inside the claim?
To make the ledger confusing and complicated
To keep the claim open to follow up if payment is missed
To keep from applying it to the pt's regular insurance max
To keep track of how many ortho accounts we have in-office
46
What is the easiest thing we can do to prevent account audits?
Write good notes when posting checks
Split family members onto their own accounts
Collect DOS
Verify insurance
47
Which is a reason to update treatment plan fees.
Treatment plan is over 30 days old
Patient changed insurance companies
All of the above
Prior to presenting a tx plan to a new patient
48
What is the allowed amount on the following EOB?
$80
$106
$42
$64
49
Does a D0097 courtesy call posted to the ledger of an Over 180 account qualify as "activity"?
Yes
No
50
Which of the following is a preventable adjustment?
Insurance adjustments
Primary/Secondary Adjustments
Delta Premier Adjustments
FP Adjustments
51
The purpose of working the insurance aging report is
To give our BAs something to do
To make sure the patient is eligible for benefits
To find out why a claim hasn't been paid and get it paid
To look online if a claim is on file with insurance
52
On One-Click Submit, what is the best way to honor our patient's stated monthly budget amount?
Care Credit website
Budget Tool
Calculator
My Smile Care
53
What are steps 5, 6 and 7 of the SRS?
Specialty follow-up, Lab cases & Pre-auths, Smile Blast
Inform the team, Pts in chair, Pts in reception area
Lab cases & Pre-auths, Smile Blast, Work reports
Pts 2-3 weeks out, Specialty F/U, Lab cases & Pre-auths
54
What is Thrive for % Over 90 Insurance?
4%
5%
10%
6%
55
Insurance overpays due to credentialing. We debit up the difference so a credit isn't created.
False
True
56
We make a courtesy call for all patients with a balance over _________ days with no payment.
90
120
30
60
