Check Your Understanding 19.2

Chose the best answer:

1. Analytics that describe a provider's unique characteristics in a local market aids:

a. Contract negotiation

b. Individual enrollment in a health plan

c. Physician enrollment in a health plan

d. Reduction in bad debt

2. A service that can increase revenue may be obtained through:

a. Online bill paying

b. Point of service payment

c. Preventive service reminders

d. Positive patient identification

3. Failure for a provider to conduct which of the following transactions will result in a large number of claims denials?

a. Claims attachments

b. Claims status

c. Eligibility verification

d. Premium payment

4. A successful strategy to improve collection of a patient's balance after insurance is:

a. Discount for early payment

b. Investment counseling

c. Late payment penalties

d. Pre-certification

5. Services required by health plans to ensure medical necessity include:

a. Accurate coding

b. Co-pay collection

c. Deductible management

d. Utilization review

6. A form of case management addressing care after patients leave a provider setting is:

a. Care coordination

b. Claims audits

c. Drug utilization review

d. Medical necessity checks

7. A charge description master:

a. Catalogs supplies and services

b. Creates accounts receivables

c. Reconciles A/R with payments

d. Supports correct coding

8. Which of the following may no longer be necessary in a future value-based payment environment?

a. Claims submission

b. Coding

c. Eligibility verification

d. Prior authorization

9. A document sent by the health plan to patients to identify the portion of payment that is their responsibility is:

a. Claim

b. Electronic remittance advice

c. Explanation of benefits

d. Invoice

10. Information that helps providers understand the amount being reimbursed by a health plan is:

a. Claims adjustment reason codes

b. Electronic remittance advice

c. Explanation of benefits

d. ICD-10-CM/PCS or CPT codes