Medical Office Administration and Billing Flashcards

What is an accounts receivable (A/R) aging report used for in a medical office?

Answer: Monitoring outstanding balances by how long they have been unpaid

An A/R aging report categorizes unpaid balances by time period (0-30, 31-60, 61-90+ days), helping identify overdue accounts needing collection action.

Which CPT code range covers Evaluation and Management (E/M) services?

Answer: 99201-99499

CPT codes 99201-99499 cover Evaluation and Management services including office visits, hospital care, and consultations.

What is the purpose of verifying patient insurance eligibility before an appointment?

Answer: To confirm active coverage, benefits, and patient financial responsibility before services are rendered

Eligibility verification confirms the patient has active insurance coverage and identifies deductibles, copays, and covered benefits to avoid claim denials.

Under the False Claims Act, which action is considered healthcare fraud?

Answer: Submitting a claim for services that were never provided

Submitting claims for services not rendered is fraud under the False Claims Act and can result in treble damages, exclusion from federal programs, and criminal penalties.

What does 'balance billing' mean?

Answer: Charging the patient for the difference between the provider's fee and what the insurance paid

Balance billing occurs when a provider charges the patient for the amount above what the insurer paid; it is often prohibited for in-network providers under contract.

Which document formally requests payment from an insurance company for medical services?

Answer: A health insurance claim

A health insurance claim is submitted to the payer with patient, provider, diagnosis, and procedure information to request reimbursement for services rendered.