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