Assessment 04 – Informatics and Nursing-Sensitive Quality Indicators For this

The appeal process has two levels: an internal process and an external process. Group of answer choices True False Flag question: Question 2Question 21 pts What does COB stand for? Group of answer choices Coordination of Beginnings Coordination of Beliefs Coordination of Begging Coordination of Benefits Flag question: Question 3Question 31 pts The aging report allows office staff to set priorities on which accounts to address first. Follow-up may include (select all that apply): Group of answer choices Contacting third-party payers to find out why a claim is delayed. Offer the patient financial assistance through a payment plan or send an account to a collection agency. Calling the Better Business Bureau to see if the patient has bad credit. Calling the patient to inquire why payment has been delayed. Flag question: Question 4Question 41 pts When posting payments a write-off for an in-network physician is Group of answer choices The difference between the provider’s actual charge and the patient responsibility Does not need to be written-off The write-off is the patient responsibility The difference between the provider’s actual charge and the insurance company’s allowable charge Flag question: Question 5Question 51 pts All the following are true in the appeals process EXCEPT: Group of answer choices If the appeal concern is for services already received the payer has 60 days to respond. If the appeal concerns urgent care, the payer must respond within 72 hours of receiving the request. If the appeal concern is non-urgent care not yet received the payer has 30 days to respond. If the appeal concerns urgent care, the payer must respond within 24 hours of receiving the request. Flag question: Question 6Question 61 pts Denials occur for various reasons except for Group of answer choices Pre-existing condition not covered by the patient’s policy Invalid dates of service Patient no longer covered under the policy Medical necessity has been met Flag question: Question 7Question 71 pts If a patient has an employer-based plan and Medicaid, which is primary and secondary? Group of answer choices Primary = Medicaid; Secondary = Employer-Based Primary = Employer-Based; Secondary = Medicaid Flag question: Question 8Question 81 pts The aging report is maintained in 30-day increments, also known as buckets. Which bucket should dramatically drop as third-party payers process claims and payment is received by the payers and patients for services rendered? Group of answer choices 31-60-day bucket 61-90-day bucket 91-120+ bucket 0-30-day bucket Flag question: Question 9Question 91 pts From the insurance company, all the following are included along with the denial of a claim EXCEPT: Group of answer choices Acknowledgment of the right to an internal appeal Acknowledgment on the right to request an external review if the internal review was unsuccessful A reason the claim was denied The patient’s PHI Flag question: Question 10Question 101 pts An explanation of benefits (EOB) is a written or electronic explanation sent by the payer to Group of answer choices The patient’s employer The nurse The provider The patient

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