Chapter 24 — Quiz
26 questions. Answers and explanations are in the instructor guide.
1. The largest single category of preventable denial in most organizations is created:
- A. By coders selecting the wrong code
- B. At registration
- C. By payers applying proprietary edits
- D. In the clearinghouse
2. An error caught at registration versus the same error worked as a denial consumes staff time in a ratio of approximately:
- A. 3 to 1
- B. 15 to 1
- C. 90 to 1
- D. The same either way
3. A wrong patient address produces:
- A. A denial for invalid demographics
- B. A rejection at the clearinghouse
- C. No denial at all — a patient who never receives a bill and an account that ages
- D. A duplicate claim
4. The most expensive registration field is:
- A. The member identification number
- B. The date of birth
- C. "Has anything changed?"
- D. The group number
5. Which month produces the most registration errors?
- A. July
- B. January
- C. December
- D. They are evenly distributed
6. Verifying the identity of the person presenting is primarily:
- A. A revenue protection measure
- B. A patient safety matter, because medical identity theft contaminates the victim's record
- C. Required only for new patients
- D. A HIPAA authorization requirement
7. A 270 is:
- A. The eligibility response
- B. The eligibility and benefit inquiry
- C. The claim
- D. The prior authorization request
8. Which transaction is the prior authorization request and response?
- A. 276/277
- B. 278
- C. 837
- D. 834
9. The deductible amount returned on an eligibility response:
- A. Is always current
- B. Reflects claims the payer has processed, and therefore lags
- C. Is guaranteed for 30 days
- D. Includes claims incurred but not submitted
10. An estimate built on a lagging deductible figure will most likely:
- A. Ask the patient for too little
- B. Ask the patient for too much
- C. Be exactly right
- D. Be rejected by the payer
11. "Other coverage: none indicated" on a 271 means:
- A. The patient has no other coverage
- B. The payer has no other coverage on file
- C. Coordination of benefits has been resolved
- D. Medicare is primary
12. Eligibility should be verified:
- A. Once, at check-in
- B. Once, at scheduling
- C. At scheduling, 48–72 hours before, and on the day of service
- D. Only for new patients
13. Which verification point is the only one at which the encounter can still be rearranged?
- A. Day of service
- B. 48–72 hours before
- C. At scheduling
- D. After the visit
14. A referral is about:
- A. What service is performed
- B. Who the patient sees
- C. Where the service is performed
- D. When the service is performed
15. A predetermination is:
- A. A binding authorization
- B. A non-binding advance review of whether a service would be covered
- C. Required for all elective surgery
- D. Another word for precertification
16. Which is NOT among the eight things to record about an authorization?
- A. The approved date range
- B. The approved number of units
- C. The patient's copayment amount
- D. The approved rendering provider
17. An authorization number recorded without its scope is:
- A. Sufficient for billing
- B. A number, not a record
- C. Required by HIPAA
- D. Valid for 90 days
18. A 271 reporting no other coverage is insufficient for coordination of benefits because:
- A. The transaction is optional
- B. It reflects the payer's records, and the questionnaire asks the patient
- C. It expires in 24 hours
- D. Medicare does not participate in the transaction
19. Billing Medicare as primary when another payer is primary is:
- A. Acceptable if corrected later
- B. An overpayment, to which the sixty-day rule attaches on identification
- C. A rejection, not a denial
- D. Permitted for emergency services
20. A patient with Medicare is treated for an injury sustained at work. Primary is generally:
- A. Medicare
- B. The spouse's group health plan
- C. Workers' compensation
- D. The patient
21. Which is prohibited?
- A. Offering a payment plan
- B. Offering financial assistance under a written policy
- C. Routinely waiving patient cost-sharing
- D. Collecting a copayment at check-in
22. The better collection script asks about:
- A. Whether the patient wants to pay
- B. Method of payment, stating the amount as a fact
- C. The patient's income
- D. Whether the patient has questions
23. A patient estimate should be computed from:
- A. The practice's charge
- B. The allowed amount
- C. The chargemaster
- D. The prior year's payment
24. An estimate of \$16.98 assumes a met deductible. If the deductible is not actually met, the patient's share for the same services becomes:
- A. \$16.98
- B. \$33.96
- C. \$84.88
- D. \$0.00
25. Account 10-4471's front desk collected \$30.00 and the patient's actual responsibility was:
- A. \$30.00
- B. \$47.58
- C. \$17.58
- D. \$168.70
26. The one thing Account 10-4471's front desk missed was:
- A. Verifying eligibility
- B. Collecting the copay
- C. Asking what the visit was for
- D. Checking for a referral requirement