Administrative Skills Flashcards

When a patient's insurance claim is denied due to 'lack of medical necessity,' the medical assistant should:

Answer: Obtain and attach supporting clinical documentation for an appeal

A denial for lack of medical necessity requires an appeal with clinical documentation (physician notes, test results) that justifies the services rendered.

Which document outlines the patient's responsibility for payment at the time of service?

Answer: Financial policy / patient financial responsibility form

The financial policy or patient financial responsibility form informs patients of copays, deductibles, and payment expectations at or before service.

The term 'accounts receivable' in a medical office refers to:

Answer: Money owed TO the practice by patients and insurers

Accounts receivable (A/R) represents money owed to the practice for services already rendered but not yet collected.

Which scheduling approach leaves open slots throughout the day for same-day urgent appointments?

Answer: Open-access / advanced access scheduling

Open-access (advanced access) scheduling reserves a portion of daily slots for same-day acute needs, reducing patient wait times.

A tickler file in a medical office is used to:

Answer: Track future tasks and follow-up reminders by date

A tickler file is a date-indexed reminder system that prompts staff to follow up on tasks, recalls, or pending items on specific future dates.

CPT modifier -25 is appended to indicate:

Answer: A significant, separately identifiable E/M service was performed on the same day as a procedure

Modifier -25 signals that a significant, separately identifiable Evaluation and Management service was performed on the same date as a minor procedure.