Medical Billing Software Patient Billing & Account Management 1 — Questions and Answers
Question 1: What is the primary purpose of a patient statement in medical billing?
- To notify the patient of the balance owed after insurance has been applied (Correct answer)
- To submit claims to insurance carriers
- To document diagnosis codes for a patient visit
- To verify patient insurance eligibility
Correct answer: To notify the patient of the balance owed after insurance has been applied
A patient statement is sent to inform the patient of their remaining balance after insurance payments and adjustments have been applied.
Question 2: Which document does an insurance company send to a patient explaining how a claim was processed?
- Remittance Advice (RA)
- Explanation of Benefits (EOB) (Correct answer)
- Superbill
- Advance Beneficiary Notice (ABN)
Correct answer: Explanation of Benefits (EOB)
An Explanation of Benefits (EOB) is sent by insurers to patients detailing how claims were processed, what was paid, and what the patient owes.
Question 3: A patient has a $200 balance after insurance. The billing office sets up a payment plan. What is the primary benefit of a payment plan for the practice?
- It eliminates the need for collections entirely
- It increases the likelihood of recovering the balance while maintaining the patient relationship (Correct answer)
- It allows the practice to charge additional interest fees automatically
- It transfers the account to a third-party collector immediately
Correct answer: It increases the likelihood of recovering the balance while maintaining the patient relationship
Payment plans improve collection rates by making balances manageable for patients while preserving the patient-provider relationship.
Question 4: In medical billing software, what does 'patient aging' refer to?
- The patient's date of birth recorded in the system
- A report showing outstanding patient balances categorized by how long they have been unpaid (Correct answer)
- The length of time a patient has been receiving care at the practice
- A Medicare eligibility determination based on the patient's age
Correct answer: A report showing outstanding patient balances categorized by how long they have been unpaid
Patient aging reports categorize outstanding balances into time buckets (0–30, 31–60, 61–90+ days) to help prioritize collection efforts.
Question 5: What is a 'credit balance' on a patient account?
- A balance the patient owes to the practice
- An amount owed to the patient because of overpayment (Correct answer)
- A pre-authorized credit for future services
- A balance that has been transferred to a collection agency
Correct answer: An amount owed to the patient because of overpayment
A credit balance occurs when a patient or insurer has overpaid, meaning the practice owes money back to the patient.
Question 6: Which action should a billing specialist take first when a patient calls to dispute a charge?
- Transfer the account to a collection agency
- Review the patient's account ledger and EOB to verify the charge (Correct answer)
- Write off the disputed amount immediately to avoid conflict
- Request payment in full before investigating the dispute
Correct answer: Review the patient's account ledger and EOB to verify the charge
Reviewing the account ledger and EOB helps determine whether the charge is accurate before taking any further action on the account.
Question 7: What is the purpose of a financial assistance (charity care) program in medical billing?
- To increase patient co-pays for high-income patients
- To provide discounted or waived fees for patients who cannot afford care (Correct answer)
- To transfer balances to a government assistance program automatically
- To reduce reimbursement rates for all patients equally
Correct answer: To provide discounted or waived fees for patients who cannot afford care
Charity care programs help uninsured or underinsured patients receive care by reducing or eliminating their financial obligation based on income.
Medical Billing Software Patient Billing & Account Management 1
What is the primary purpose of a patient statement in medical billing?