Chapter 24 — Exercises

How to use these. Section A is arithmetic and it is the chapter's argument. Sections F and G are scripting — write the actual words, do not describe what you would say. A front-desk conversation is a skill and it is practiced the way any skill is.

Section A — The cost of an error (items 1–6)

A.1 A transposed digit in a member identification number. Name the five points at which it can be caught and what happens at each.

A.2 Give the approximate staff minutes at each of the first four.

A.3 State the ratio between the first and the fourth. Why does the chapter give it in minutes rather than dollars? Give both reasons.

A.4 What is lost at the fifth point?

A.5 The chapter declines to convert its table into dollars. Name the rate it would need, say which chapter publishes it, and say which chapter owns the conversion for Account 10-4471 specifically.

A.6 The chapter says an organization that will not fund thirty seconds is buying roughly ninety times as much back-office time instead. Why does that trade get made? Name the structural reason, not a failure of intelligence.

Section B — Registration fields (items 7–18)

For each, state what goes wrong and what question prevents it.

B.7 A patient introduces herself as "Beth."

B.8 A date of birth is entered as 06/13 rather than 06/31.

B.9 A member number is copied from the previous visit.

B.10 An adult patient is recorded as their own subscriber.

B.11 The plan is recorded as "Blue Cross."

B.12 The address is three years old.

B.13 The patient injured their shoulder lifting boxes at work and nobody asked.

B.14 A returning patient's record is copied forward without a question.

B.15 In B.12, what denial results? Explain your answer carefully.

B.16 Name the four alphanumeric confusions in member identification numbers.

B.17 Which month produces the most registration errors, and why?

B.18 State the one scripted question that catches the entire "has anything changed" category, and say how long it takes.

Section C — Identity (items 19–22)

C.19 What is the front-desk duty that is not about billing?

C.20 Name the three consequences of medical identity theft, in ascending order of seriousness.

C.21 Which one cannot be unwound?

C.22 A patient's identification does not match the name on the coverage. What is the correct posture, and why?

Section D — Eligibility (items 23–34)

D.23 What is a 270? A 271?

D.24 Name six things the transaction can tell you.

D.25 Name four things it cannot.

D.26 Why does the deductible figure lag? In which direction does an estimate built on it err?

D.27 "Other coverage: none indicated." What does that sentence actually assert?

D.28 Does a 271 tell you whether a service is medically necessary? What does Chapter 22 require instead?

D.29 Name the three points at which eligibility should be verified.

D.30 What does each one catch?

D.31 Which point is the only one at which the encounter can still be rearranged?

D.32 Distinguish batch from real-time verification. Which is used where?

D.33 Why does the chapter call the 48-hour check the one that pays for itself?

D.34 State the three questions to ask of any eligibility response.

Section E — Referrals, authorizations, and who obtains them (items 35–46)

E.35 Define a referral. Whose responsibility is it generally?

E.36 Define a prior authorization. Is it about who or what?

E.37 Define a precertification. What should you do when a payer uses the word?

E.38 Define a predetermination. Is it binding?

E.39 A scheduler says "we have a referral, so we don't need an authorization." Respond.

E.40 Name the eight things to record about an authorization.

E.41 (Chapter 22) Which four of the eight correspond to the four drifts in Chapter 22's Case Study 1?

E.42 Why is an authorization number recorded without its scope "a number, not a record"?

E.43 Name three documented failures that follow from recording only a number.

E.44 A PCP orders advanced imaging performed at an imaging center. Who obtains the authorization?

E.45 Name the three principles that resolve most such disputes.

E.46 What must be communicated along with the authorization number, and to whom?

Section F — MSP and cost-sharing (items 47–54)

F.47 What does the MSPQ determine?

F.48 Name five circumstances in which Medicare may be secondary.

F.49 Why is a 271 reporting "no other coverage" insufficient?

F.50 What is the consequence of billing Medicare as primary when another payer is primary?

F.51 A 68-year-old with Medicare and spousal group coverage from a 900-employee firm is seen for a back injury sustained at her part-time job. Which payer is primary? Give the full reasoning.

F.52 In F.51, how many independent reasons make Medicare not primary? Name both.

F.53 What may a practice do about patient cost-sharing? Name four things.

F.54 What may it not do? What word is doing the work in the prohibition, and why?

Section G — Asking, clearing, estimating (items 55–62)

G.55 Rewrite "Would you like to pay your copay today?" and explain why yours works.

G.56 Name three things that make the collection conversation worse.

G.57 A patient says they cannot pay today. What do you do, and which two sections of Chapter 32 exist for this?

G.58 List the nine items of financial clearance.

G.59 Which item is the highest-value one that almost nobody does? What does it catch, and which chapter's apparatus does it apply?

G.60 Build an estimate: 20610 allowed \$78.60, J1030 allowed \$6.28, deductible met, 20% coinsurance. Show the arithmetic.

G.61 In G.60, what does the figure become if the deductible is not actually met? Express the difference as a multiple.

G.62 Write the sentence that accompanies the estimate. It must name the specific thing that could move.

Section H — Measurement (items 63–66)

H.63 Name five front-end measures.

H.64 Which one requires Chapter 29 §29.4's classification to compute at all?

H.65 State the sixth measure, and explain what a high answer means versus a low answer.

H.66 "The front end is measured by the back end's failures and staffed by the front end's budget." Explain the behavior that sentence predicts, and state the fix.

Section I — The Encounter (items 67–70)

I.67 Name the five things Account 10-4471's front desk did correctly.

I.68 Name the one thing it missed. Was it an error?

I.69 The copay collected was \$30.00 and the patient's responsibility was \$47.58. Explain the difference, line by line.

I.70 Name the three cheap things a better front end would have done. Which one would have made the day-70 statement expected rather than a surprise?