Medical Billing Software Medical Billing General 5

Question 1

A patient's insurance plan has a $2,000 out-of-pocket maximum. Once met, what happens to the patient's cost-sharing?

Accepted Answer

The insurance covers 100% of covered services for the rest of the benefit period

Answer

After the out-of-pocket maximum is reached, the insurance plan pays 100% of covered in-network services for the remainder of the plan year.

Question 2

Which type of medical billing software feature automates the process of verifying patient eligibility before an appointment?

Accepted Answer

Real-time eligibility verification

Answer

Real-time eligibility verification queries payer databases electronically to confirm a patient's active coverage, benefits, and cost-sharing before the visit.

Question 3

What is a 'dirty claim' in medical billing terminology?

Accepted Answer

A claim that contains errors or missing information requiring correction before payment

Answer

A dirty claim contains incomplete, invalid, or inconsistent data that causes the payer to suspend, reject, or deny it without payment.

Question 4

Which revenue cycle metric measures the average number of days it takes to collect payment after a service is rendered?

Accepted Answer

Days in accounts receivable (DAR)

Answer

Days in accounts receivable (DAR) quantifies the average time from service delivery to payment receipt, with lower values indicating a more efficient revenue cycle.

Question 5

When a provider does not participate in a patient's insurance network, how is billing typically handled?

Accepted Answer

The provider bills the patient directly or submits as out-of-network with higher patient cost-sharing

Answer

Out-of-network providers bill at their standard rate, and patients typically owe higher cost-sharing; the provider may bill the patient for balances not covered by the plan.

Medical Billing Software Practice Test

Medical Billing Software Practice Test

Medical Billing Software Medical Billing General 5