Action Urgent care Front Office Exam

The statement is false because the unmet deductible fee cannot be waived if the patient does not want to pay. The unmet deductible is an amount that the patient is responsible for paying before the insurance coverage kicks in. It is a contractual obligation between the patient and the insurance company, and cannot be waived at the patient's discretion.

The statement states that we can offer the patient to pay 50% of their outstanding statement balance as long as the balance is less than 30 days old. This implies that if the balance is less than 30 days old, the patient can avail the offer to pay only 50% of their outstanding balance. Therefore, the answer is true.

If the Family deductible or Individual deductible states $0 In-Plan Network, it means that there is no deductible amount that needs to be paid by the insured individuals before the insurance coverage kicks in. In this case, we can move directly to collecting a copay fee for the services rendered, without needing to collect a deductible fee. Therefore, the statement is true.

Cash payments are to be manually inputted and allocated in DrChrono. This means that when a patient pays in cash, the healthcare provider or staff member needs to manually enter the payment information into the DrChrono system. They also need to allocate the payment to the appropriate patient account. This process is not automated and requires manual input from the user. Therefore, the statement "Cash payments are to be manually inputted and allocated in DrChrono" is true.

The correct answer is "We do not recollect $225 within 10 days for F/U same chief complaint." This means that if a patient comes back within 10 days with the same chief complaint, they will not be charged an additional $225. This rule allows for continuity of care and prevents patients from being charged for multiple visits for the same issue within a short period of time.

The correct order to verify eligibility is Out of Pocket (Stop Loss), Deductible, Copay, Coinsurance. This means that the first step is to check if the individual has reached their out-of-pocket maximum or stop loss limit. Then, the deductible amount is verified to see if it has been met. After that, the copay amount is checked, followed by the coinsurance percentage.

The statement "We accept HMO insurance without prior authorization" is false. This means that the organization does not accept HMO insurance without prior authorization.

Making an appointment for a patient at AHC during the nurses' lunch break is not possible. The statement suggests that appointments can be scheduled during this time, but the correct answer states that it is false. This implies that appointments cannot be made during the nurses' lunch break at AHC.

It is not appropriate to email a patient's lab results or disclose them over the phone upon request. This violates patient privacy and confidentiality, as email and phone communication are not secure methods for transmitting sensitive medical information. Patient lab results should be communicated through secure and confidential channels, such as in-person consultations or secure online portals.

The AUC deductible fee is $225.

The correct answer is $100. This means that if a patient chooses to pay for the TB skin test themselves, they would have to pay $100. This suggests that there is a cost associated with the test and it is not covered by insurance.

The statement "We accept Medicare part A" is false. This means that the organization or entity being referred to does not accept Medicare part A as a form of payment or insurance coverage.

The statement is true because when a patient cancels an appointment or walks out, it is important to gather feedback and understand the reasons behind their decision. The Cancellation Survey helps in collecting this information, which can be used to improve the appointment scheduling process or address any issues that may have led to the cancellation. By filling out the survey, healthcare providers can gain valuable insights and make necessary adjustments to enhance patient satisfaction and retention.

The correct answer is "SMCA1 CA Medicare Part B North". This is the insurance name and payer ID for Medicare.

Follow-up appointments are not free.

Based on the information provided, we would look at the co-insurance. The co-insurance percentage mentioned (40%) indicates the portion of the medical expenses that the patient is responsible for paying after the deductible has been met. This suggests that the patient will be responsible for paying 40% of the costs for services received within the plan network.

The explanation for the given correct answer is that based on the information provided, the patient has Aetna insurance and the front of the insurance card states Urgent Care $50. Therefore, it is reasonable to collect the $50 copay from the patient, as indicated on the insurance card.

Based on the given information, the insurance eligibility states that the deductible is not applicable, the copay is in the plan network, and the coinsurance is not applicable. Therefore, the only thing that needs to be collected is the copay.

The statement is true because when a patient does not show up for their appointment or cancels it, we need to change the appointment status to "No Show" in order to accurately reflect the patient's attendance. Additionally, we input the appropriate cancellation CPT code under custom codes to indicate the reason for the cancellation. Finally, it is important to document these details in the appointment notes for future reference and record keeping purposes.

If a patient has met their Out-of-Pocket Stop Loss, it means that they have already reached the maximum amount they need to pay for their healthcare expenses in a given period. Therefore, there is no need to collect their deductible, copay, or coinsurance because they have already fulfilled their financial obligations. In this case, the healthcare provider can bill the insurance first for the remaining expenses.

The statement is false because AHC can see patients who are 3 months old and above.

When a patient is self-pay, it means that they are responsible for covering their own medical expenses without the assistance of insurance or any other third-party payer. Therefore, the payment profile is changed to cash, as the patient is expected to make a direct payment in cash for the services they receive.

Every patient needs to provide their driver's license or a form of identification, credit/debit card, and health insurance card. These documents are necessary for identification purposes, payment processing, and verification of health insurance coverage.

The correct answer is $45. This is the cost of sports physicals.

The given statement is true. It states that Stanford HealthCare Alliance and Stanford HealthCare Advantage are accepted without prior authorization, even if it states HMO (Health Maintenance Organization) on the card. This means that individuals with these insurance plans can receive healthcare services from Stanford HealthCare without needing to go through a prior authorization process.

Checking the Health Net website for eligibility is a necessary action to determine if a patient's insurance coverage includes Health Net. By doing so, healthcare providers can ensure that the patient's services will be covered by the insurance company before providing any treatment or services. This step helps to avoid any potential issues with reimbursement or denial of claims.

The correct answer is "Receptionist/MA informs patient that patient has to pay out-of-pocket for the supply and charge accordingly to Self Pay schedule." This statement is true because it states that the patient is responsible for paying for the orthopedic supply themselves, and the amount will be based on the Self Pay schedule.

The cancellation and No Show fee for Ultrasounds is $200. This means that if a person cancels their ultrasound appointment or fails to show up for it, they will be charged $200.

The correct answer is "Deductible." In insurance eligibility, the deductible is the amount that the insured individual must pay out of pocket before the insurance company starts covering the costs. In this case, the deductible is stated as being in the in-plan network and has a remaining amount of $870.19. Therefore, the correct answer is the deductible.

Based on the information provided, the patient's insurance states that their deductible has been met and the copay for Urgent Care is $20. However, it also states that the copay for a Physician Office Visit for a Sick visit is $0. Therefore, based on the patient's status, we would collect $0 for a Physician Office Visit for a Sick visit, not Urgent Care. Hence, the correct answer is False.

The explanation for the given correct answer is that the patient still has an unmet deductible, which means they have not yet reached the amount required to be paid out of pocket before their insurance coverage kicks in. Since the patient has already paid $225 towards their deductible for the pink eye visit, they would still need to pay another $225 for the UTI visit, as it is a separate occurrence and the deductible has not been met yet. Therefore, the statement "We would collect another unmet deductible fee $225 again" is true.

It is not okay to see the patient and bill them later if they have an outstanding balance and cannot afford to pay it today. It is important to address the outstanding balance before providing any additional services to the patient. This ensures that the healthcare provider receives payment for the services rendered and avoids accumulating further debt for the patient.

The correct answer is $130. This is because an intermediate visit at AHC includes both a consultation and a rapid strep test, which are additional services compared to a basic visit. These additional services contribute to the higher cost of $130.

The correct answer is "We work like a hospital the nurse do all the hands on work and we select the appropriate doctor to consult you on your condition." This response explains the process at the AHC clinic, where the nurse performs the necessary tasks and a doctor is consulted for the patient's condition. It assures the patient that they will receive appropriate care despite there not being a provider onsite.

The statement is false because with HMO insurance, it is not necessary to run insurance eligibility or collect fees at the time of the visit. HMO insurance typically requires a referral from a primary care physician and has a set network of providers. Therefore, the patient's eligibility and fees would have already been determined prior to the visit.

You do not have to contact the Billing Department to send medical records to the patient's Primary Care Physician. The Billing Department is responsible for handling financial matters and invoices, not the transmission of medical records. Instead, you would typically contact the Medical Records Department or the healthcare provider directly to send medical records to the patient's Primary Care Physician.

The AHC Self-Pay fee is $100.

The correct answer is to collect the patient's credit card information, inform them that their insurance will be billed first, and proceed with seeing the patient today. This protocol allows the healthcare provider to bill the patient's insurance and potentially receive reimbursement for the services provided. It also ensures that the patient can still receive the necessary medical care without delay.

The statement suggests that Tricare can be accepted without physical insurance cards if the individual provides their Driver's License and primary subscriber's Social Security Number. Therefore, it is true that Tricare can be accepted with these alternate forms of identification.

The correct answer is $300. This means that at AUC, the cost of a consultation plus an X-Ray is $300.

A patient with Traveler's insurance is required to have a form with the Authorization to treat, a form of identification (Passport or DL), and a CC in Collectly. The form with the Authorization to treat is necessary to ensure that the patient has given consent for medical treatment. The form of identification is needed to verify the patient's identity and confirm their eligibility for Traveler's insurance. The CC in Collectly is required to collect payment for the medical services provided.

The insurance name and Payor ID for Anthem Blue Cross/PPO is 47198 CA Anthem Blue Cross.

If you run across an insurance we do not see often, and Dr. Chrono won't let you run eligibility, then you should enter payer ID and claim information based on the back of the insurance card, collect the copay listed on the front of the card, and CC in Colleclty. This means that you should manually enter the necessary information from the insurance card into the system, collect the copay amount specified on the front of the card, and make sure to document the patient's insurance information correctly in the system.

The correct order to input a cash payment into Dr Chrono is to first go to the Balance tab, then the Patients payments tab, followed by clicking on Add. After that, you need to email Liana and CC the Ops Manager. This order ensures that the cash payment is properly recorded and communicated to the relevant parties.

The additional charge should be $200. This is because the patient received IV therapy, Nebulizer treatment, EKG testing, and medication administration, which are all additional services beyond a simple consultation. Since the initial charge was $200, the total amount charged should be $400 to match for the services provided.

The correct answer suggests that when encountering an error in running eligibility on PPO, the first step is to double-check all insurance information to ensure it is entered correctly. Additionally, if a copay is listed on the front of the insurance card, it should be collected. If there is no copay listed and the insurance is active, the insurance should be billed first.

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If Urgent Care is stated to be "Non-Covered," the correct course of action is to put the patient's credit card on file and inform them that their insurance will be billed. This means that the patient will be responsible for paying for the Urgent Care services out of pocket initially, but the medical facility will still attempt to bill their insurance for reimbursement.

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On DrChrono, we do not need to run insurance eligibility for Medicare, workers comp, and auto insurance. This means that for these insurances, there is no need to verify the patient's eligibility or coverage before providing them with medical services.