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