Financial Management and Accounting Flashcards

A patient's EOB shows a $150 contractual adjustment. What does this mean?

Answer: The provider wrote off $150 as part of their payer contract

A contractual adjustment is the amount a provider agrees to write off based on their negotiated contract with the insurance payer.

Which report shows the total amount billed, collected, and adjusted for a given period?

Answer: Day sheet (daily journal)

The day sheet (daily journal) summarizes all financial transactions—charges, payments, and adjustments—for a specific day or period.

A claim is denied because the procedure is 'not medically necessary.' What is the FIRST step?

Answer: Review documentation and file an appeal with supporting clinical notes

When a claim is denied for medical necessity, the correct first step is to gather supporting documentation and submit a formal appeal to the payer.

What is the purpose of a remittance advice (RA)?

Answer: To inform the provider of claim payment decisions and any adjustments made

A remittance advice explains which claims were paid, denied, or adjusted and provides the reasons for each decision.

Which of the following is an example of accounts payable in a medical office?

Answer: An unpaid invoice for medical supplies ordered from a vendor

Accounts payable refers to money the practice owes to outside vendors or suppliers for goods and services received.

When posting a payment from Medicare, the CMAA notices the payment is less than expected. What should be checked first?

Answer: The Medicare fee schedule for that procedure code

Comparing the payment to the Medicare fee schedule helps determine if the payment is correct or if an error or denial has occurred.

A patient has a $500 deductible, has met $300 so far, and receives a $400 service. How much of this visit applies to the deductible?

Answer: $200

The patient still needs $200 more to meet the $500 deductible ($500 − $300 = $200), so $200 of the $400 service applies to the deductible.