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