Ch. 16 study guide 2022 100% Correct
Bookkeeping – ANSWER Recording of all financial transactions in the patient account
records
Manual bookkeeping - ANSWER-Also called a pegboard system
-uses a day sheet to record all financial transactions for the date of service and
maintains patient account balances by using physical cards.
-transactions are initiated before the patient goes to the examination room
-Gets its name from the lightweight aluminum or Masonite board that is used. It has a
row of pegs along the side or top that holds the forms in place
-allows the medical assistant to keep control over cash, collections, and receivables and
ensures that every cent is accounted for and properly entered.
-generates all the necessary financial records for each transaction (by writing once with
carbon paper) as follows: Encounter form, Receipt, Patient account ledger card and
Bookkeeping transaction entry.
Credit Balances - ANSWER-occurs when a patient has paid in advance, or an
overpayment/duplicate payment is made
- creates a debit in the patient account
-Medical assistant should investigate to whom is owed (patient or insurance company).
-The first place to investigate is the EOB from the insurance company; this document
shows the exact amount of the patient's financial responsibility.
-The medical assistant should confirm that all the line items match the corresponding
amounts on the EOB because many credit balances are created when an error is made
in payment posting
Refunds - ANSWER- Made to insurance companies for overpayments made on patient
accounts
Refunds create a credit in the patient account that needs to be accounted for
-Once the amount is confirmed, medical office manager should send insurance
company a check, along with necessary documentation
-The medical assistant should review the EOB to confirm that an overpayment has, in
fact, occurred.
- The medical assistant should contact provider services at the health insurance plan to
confirm which payment they were supposed to receive and the reasoning behind the
payment amount.
-Credit balances and refunds, if not handled properly, can reduce what is owed to the
provider enormously.
Truth in Lending Act - ANSWER-Enforced by the Federal Trade Commission (FTC)
-Part of Consumer Credit Protection Act
Requires that individuals be provided certain information when credit is extended
-Annual percentage rate (APR)
-Terms of the loan
-Total costs to borrower
, Ch. 16 study guide 2022 100% Correct
-When offering credit options for patients, medical practice should be in compliance with
Regulation Z.
-Clinicians occasionally allow their patients to pay in installments.
-As long as no specific agreement has been made for payment to the provider in more
than four installments and no finance charge is assessed, the account is not subject to
TILA.
Medicare Advanced Beneficiary Notice - ANSWER- does not cover some healthcare
services
-provides an option for patients to pay the provider's fee in full to receive service
Medicare doesn't cover
-The patient decides whether he or she still wants to receive the services from the
provider and completes the information on the form.
Professional courtesy - ANSWER-In the past some providers did not charge
professional colleagues or their close family members for medical care
-The Stark Law was passed to eliminate fraud related to not charging friends or family
for medical care:
* Must be extended to all members of healthcare facility
*Services must be routine
*Must be set forth in writing
*Cannot be extended to Medicare patients
*Cannot violate an anti-kickback statute
Billing minors - ANSWER-Minors cannot be held financially responsible for a bill unless
they are emancipated
-Bills go to a parent or legal guardian
-If the parents are separated or divorced, the parent who brings the child in for
treatment is responsible for payment.
-Minors can be treated for certain procedures (STDs, pregnancy, and birth control)
without parental consent.
Medical Care for Those Who Cannot Pay - ANSWER-Medically indigent
-Individuals who are unable to pay for services
-In many instances, medical care of the indigent is available through social service
agencies
-Give special attention to helping these people arrange payment of medical bills
-The provider can provide only medical services. Other agencies provide hospitalization
-If a provider accepts a case in advance for which a fee will not be paid, complete
records must still be kept on the patient.
-The only deviation in procedure is that the financial record indicates no charge in the
debit column.
Pitfalls of fee adjustments - ANSWER-Patients may begin to expect all fees be reduced
-Patients may even doubt competency of a provider who habitually reduces fees
-Be sure to make negotiations "without prejudice"
Bookkeeping – ANSWER Recording of all financial transactions in the patient account
records
Manual bookkeeping - ANSWER-Also called a pegboard system
-uses a day sheet to record all financial transactions for the date of service and
maintains patient account balances by using physical cards.
-transactions are initiated before the patient goes to the examination room
-Gets its name from the lightweight aluminum or Masonite board that is used. It has a
row of pegs along the side or top that holds the forms in place
-allows the medical assistant to keep control over cash, collections, and receivables and
ensures that every cent is accounted for and properly entered.
-generates all the necessary financial records for each transaction (by writing once with
carbon paper) as follows: Encounter form, Receipt, Patient account ledger card and
Bookkeeping transaction entry.
Credit Balances - ANSWER-occurs when a patient has paid in advance, or an
overpayment/duplicate payment is made
- creates a debit in the patient account
-Medical assistant should investigate to whom is owed (patient or insurance company).
-The first place to investigate is the EOB from the insurance company; this document
shows the exact amount of the patient's financial responsibility.
-The medical assistant should confirm that all the line items match the corresponding
amounts on the EOB because many credit balances are created when an error is made
in payment posting
Refunds - ANSWER- Made to insurance companies for overpayments made on patient
accounts
Refunds create a credit in the patient account that needs to be accounted for
-Once the amount is confirmed, medical office manager should send insurance
company a check, along with necessary documentation
-The medical assistant should review the EOB to confirm that an overpayment has, in
fact, occurred.
- The medical assistant should contact provider services at the health insurance plan to
confirm which payment they were supposed to receive and the reasoning behind the
payment amount.
-Credit balances and refunds, if not handled properly, can reduce what is owed to the
provider enormously.
Truth in Lending Act - ANSWER-Enforced by the Federal Trade Commission (FTC)
-Part of Consumer Credit Protection Act
Requires that individuals be provided certain information when credit is extended
-Annual percentage rate (APR)
-Terms of the loan
-Total costs to borrower
, Ch. 16 study guide 2022 100% Correct
-When offering credit options for patients, medical practice should be in compliance with
Regulation Z.
-Clinicians occasionally allow their patients to pay in installments.
-As long as no specific agreement has been made for payment to the provider in more
than four installments and no finance charge is assessed, the account is not subject to
TILA.
Medicare Advanced Beneficiary Notice - ANSWER- does not cover some healthcare
services
-provides an option for patients to pay the provider's fee in full to receive service
Medicare doesn't cover
-The patient decides whether he or she still wants to receive the services from the
provider and completes the information on the form.
Professional courtesy - ANSWER-In the past some providers did not charge
professional colleagues or their close family members for medical care
-The Stark Law was passed to eliminate fraud related to not charging friends or family
for medical care:
* Must be extended to all members of healthcare facility
*Services must be routine
*Must be set forth in writing
*Cannot be extended to Medicare patients
*Cannot violate an anti-kickback statute
Billing minors - ANSWER-Minors cannot be held financially responsible for a bill unless
they are emancipated
-Bills go to a parent or legal guardian
-If the parents are separated or divorced, the parent who brings the child in for
treatment is responsible for payment.
-Minors can be treated for certain procedures (STDs, pregnancy, and birth control)
without parental consent.
Medical Care for Those Who Cannot Pay - ANSWER-Medically indigent
-Individuals who are unable to pay for services
-In many instances, medical care of the indigent is available through social service
agencies
-Give special attention to helping these people arrange payment of medical bills
-The provider can provide only medical services. Other agencies provide hospitalization
-If a provider accepts a case in advance for which a fee will not be paid, complete
records must still be kept on the patient.
-The only deviation in procedure is that the financial record indicates no charge in the
debit column.
Pitfalls of fee adjustments - ANSWER-Patients may begin to expect all fees be reduced
-Patients may even doubt competency of a provider who habitually reduces fees
-Be sure to make negotiations "without prejudice"
