Duke - General Billing / Client Update

1.

1 point

Whenever we initiative the Patient refunds, what are all the other information need to verify.

If the address is not complete, it will kick out at the bank and not process. This creates duplicate work because Vicki will need to reverse the refund and it will need to be reprocessed. Make sure the patient and guarantor address matches.

Refund address

All the attachment & if above 500 need to attach total account balance screen.

Make sure you review the guarantor address prior to submitting a refund.

2.

1 point

We have received a payment from BCBS twice and found manual EOB in the application. Payment received date 02/02/2012. In this scenario which action we need to take ?

Need to call & confirm, if the duplicate payment already recouped or not. If did not recouped. Need to verify the current refund address & refund.

Refund to insurance carrier.

If Claim # is different & check # was to be the same need Call & confirm the payment status.

Need to check the current vendor address in the website.

3.

1 point

Under which of the following scenarios, Medicare will Act as secondary?

If patient has blue medicare advantage plan

All of the above

Home plan & Individual Plan (GHIP)

None

4.

1 point

Medicare

This type of coverage is provided for people age 65 or older and pays for hospital claims:

A code used to describe an illness or injury

which government program provides benefits for those who are medically indigent or those who qualify financially for Health coverage

Which federal agency is responsible for paying physician and hospital bills for people age 65 or older and those who have been disable for 24 months or more.

5.

1 point

An authorization (ASB) to release information is a form used when a patient authorizes their insurance carrier to pay benefits directly to a health care provider.

True

False

6.

1 point

Employer group health plans cover work illness or injuries.

True

False

7.

1 point

MSP/CMS

8.

1 point

CMS -1500 Form

A code used to describe an illness or injury

Employer group health plans cover work illness or injuries

A code used to describe a procedure or service rendered by a health care provider

What is the name of the form used to submit medical claims for the provider's services.

9.

1 point

Charity Care Adjustment Covered only

Inpatient only

All the Duke hospital workers

Low Income patient.

Who is did not have insurance.

10.

1 point

Health Reimbursement Accounts payment

Insurance payment

sanctioned employer-funded, tax-advantaged employer health benefit plans that reimburse employees for out-of-pocket medical expenses and individual health insurance premiums

If mentioned in the Correspondence, If HRA made any overpayment, refund to Patient. Refund to patient.

One of the insured payment