CMAA Financial Management and Accounts Receivable 2 — Questions and Answers
Question 1: What is an 'Explanation of Benefits' (EOB)?
- A list of covered services in an insurance plan
- A document from an insurer detailing how a claim was processed (Correct answer)
- A patient's itemized bill for services
- A referral form from a primary care provider
Correct answer: A document from an insurer detailing how a claim was processed
An EOB is a document sent by an insurance company explaining how a claim was adjudicated, including amounts paid and patient responsibility.
Question 2: Which collection method is typically the first step when a patient's account becomes overdue?
- Sending to a collection agency
- Filing a lawsuit
- Sending a friendly reminder statement (Correct answer)
- Reporting to a credit bureau
Correct answer: Sending a friendly reminder statement
The first step in collections is typically sending a friendly reminder statement to notify the patient of the outstanding balance.
Question 3: What is the primary purpose of a 'superbill' in a medical office?
- To verify a patient's insurance coverage
- To document and charge services provided during a visit (Correct answer)
- To record a patient's medical history
- To schedule follow-up appointments
Correct answer: To document and charge services provided during a visit
A superbill is an itemized form that documents services provided during a visit, including CPT and diagnosis codes used for billing.
Question 4: What does 'balance billing' mean in medical billing?
- Billing the insurance company for 100% of costs
- Billing the patient for the difference between the provider's charge and the insurer's allowed amount (Correct answer)
- Sending a final bill after all payments are received
- Combining charges from multiple visits into one bill
Correct answer: Billing the patient for the difference between the provider's charge and the insurer's allowed amount
Balance billing occurs when a provider bills a patient for the difference between their charged amount and the insurer's allowed amount.
Question 5: A medical office's 'aging report' organizes outstanding balances by which criterion?
- Patient name alphabetically
- Amount owed from largest to smallest
- How long the balance has been outstanding (Correct answer)
- Insurance company name
Correct answer: How long the balance has been outstanding
An aging report categorizes outstanding accounts receivable by how long they have been unpaid, typically in 30-day increments.
Question 6: What information is required on a patient receipt in a medical office?
- Only the amount paid
- Date, services provided, amount charged, payment received, and balance (Correct answer)
- Only the diagnosis and treatment codes
- Patient insurance ID and provider NPI only
Correct answer: Date, services provided, amount charged, payment received, and balance
A complete patient receipt should include the date, services rendered, amount charged, payment received, and any remaining balance.
CMAA Financial Management and Accounts Receivable 2
What is an 'Explanation of Benefits' (EOB)?