Action Urgent care Front Office Exam
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True/False: We can offer the patient to pay 50% of their outstanding statement balance (not In-Collections) as long as the balance is less than 30 days old.
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True
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False
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The Action Urgent Care Front Office Exam assesses essential administrative skills required for efficient patient management. It tests knowledge on patient documentation, insurance verification, payment processes, and compliance with healthcare standards.
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- 2.
T/F: If Family deductible or Individual deductible states $0 In-Plan Network, then we move to Copay and do not need to collect a deductible fee.
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True
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False
Correct Answer
A. TrueExplanation
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.Rate this question:
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- 3.
T/F: We can waive the unmet deductible fee if the patient does not want to pay.
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True
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False
Correct Answer
A. FalseExplanation
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.Rate this question:
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- 4.
Which of the following is the correct order to verify eligibility?
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Out of Pocket (Stop Loss), Deductible, Copay, Coinsurance
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Copay, Deductible, Out of Pocket (Stop Loss), Coinsurance
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Deductible, Out of Pocket (Stop Loss), Coinsurance, Co pay
Correct Answer
A. Out of Pocket (Stop Loss), Deductible, Copay, CoinsuranceExplanation
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.Rate this question:
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- 5.
T/F: We accept HMO insurance without prior authorization.
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True
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False
Correct Answer
A. FalseExplanation
The statement "We accept HMO insurance without prior authorization" is false. This means that the organization does not accept HMO insurance without prior authorization.Rate this question:
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- 6.
T/F: Cash payments are to be manually inputted and allocated in DrChrono.
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True
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False
Correct Answer
A. TrueExplanation
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.Rate this question:
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- 7.
How much is the AUC deductible fee?
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$225
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$200
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$75
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$150
Correct Answer
A. $225Explanation
The AUC deductible fee is $225.Rate this question:
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- 8.
T/F: We can make an appointment for a patient at AHC during the nurses' lunch break.
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True
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False
Correct Answer
A. FalseExplanation
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.Rate this question:
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- 9.
What is our 10 day rule for recollecting unmet deductibles?
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We do not recollect $225 within 10 days for F/U same chief complaint
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We inform the patient we are not charging them $225 for the second visit
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We collect $225 for every visit if there is an unmet deductible
Correct Answer
A. We do not recollect $225 within 10 days for F/U same chief complaintExplanation
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.Rate this question:
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- 10.
T/F: I can email a patient's lab results or tell them over the phone if they request.
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True
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False
Correct Answer
A. FalseExplanation
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.Rate this question:
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- 11.
T/F: When a patient cancels an appointment or walks-out, I have to fill out the Cancellation Survey.
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True
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False
Correct Answer
A. TrueExplanation
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.Rate this question:
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- 12.
How much are TB skin test if the patient does self-pay?
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$100
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$200
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$50
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Free because insurance covers test
Correct Answer
A. $100Explanation
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.Rate this question:
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- 13.
T/F: Follow-Up appointments are free.
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True
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False
Correct Answer
A. FalseExplanation
Follow-up appointments are not free.Rate this question:
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- 14.
What is the insurance name and payer ID for Medicare?
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36273 AARP supplement
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87726 AAARP complete
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PRNT1824 Medicare
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SMCA1 CA Medicare Part B North
Correct Answer
A. SMCA1 CA Medicare Part B NorthExplanation
The correct answer is "SMCA1 CA Medicare Part B North". This is the insurance name and payer ID for Medicare.Rate this question:
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- 15.
T/F: We accept Medicare part A.
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True
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False
Correct Answer
A. FalseExplanation
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.Rate this question:
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- 16.
T/F: If a patient met their Out-of-Pocket Stop Loss, then we do not need to collect their deductible, copay, or coinsurance. We can bill the insurance first.
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True
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False
Correct Answer
A. TrueExplanation
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.Rate this question:
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- 17.
After running eligibility for a patient, this is what is shown: Deductible states "Out of plan network." Copay states "Not applicable for Plan Network." Co-insurance states "40% In-Plan Network." Which of the following would we look at based on the information?
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Co-insurance
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Deductible
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Copay
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Out of Plan Network
Correct Answer
A. Co-insuranceExplanation
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.Rate this question:
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- 18.
T/F: For No Show/Cancellation, we change the appointment status to No Show, input the cancellation CPT code under custom codes, then document in appointment notes.
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True
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False
Correct Answer
A. TrueExplanation
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.Rate this question:
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- 19.
You run insurance eligibility and it states: "Not applicable" for Deductible, "In Plan Network" for Copay, and "Not Applicable" for Coinsurance. What do you collect?
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Copay
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Coinsurance
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Deductible
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Not applicable
Correct Answer
A. CopayExplanation
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.Rate this question:
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- 20.
T/F: A patient comes into your clinic with Aetna insurance. Eligibility gives you an error and it is the weekend. The front of the card states Urgent Care $50. You collect the $50 copay based off the front of the insurance card.
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True
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False
Correct Answer
A. TrueExplanation
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.Rate this question:
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- 21.
If a patient is SELF PAY, what is the payment profile changed to?
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Cash
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Insurance
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Check
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Credit card
Correct Answer
A. CashExplanation
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.Rate this question:
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- 22.
T/F: AHC can see patients 3 months old and up.
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True
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False
Correct Answer
A. FalseExplanation
The statement is false because AHC can see patients who are 3 months old and above.Rate this question:
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- 23.
What do we need from every patient? (Select all that apply)
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Credit/Debit card
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Driver's License or a form of Identification
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Health Insurance card
Correct Answer(s)
A. Credit/Debit card
A. Driver's License or a form of Identification
A. Health Insurance cardExplanation
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.Rate this question:
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- 24.
T/F: We accept Stanford HealthCare Alliance and Stanford HealthCare Advantage without prior authorization even if it states HMO on the card.
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True
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False
Correct Answer
A. TrueExplanation
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.Rate this question:
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- 25.
T/F: A Primary Care patient (PCP) has Blue Shield of California insurance. You run the insurance eligibility and it states their deductible has been met. When you look at copay, it states: Urgent Care "In-Plan Network" $20 and Physician Office Visit: Sick "In-Plan Network" $0. Based on the patient's status, we collect Urgent Care.
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True
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False
Correct Answer
A. FalseExplanation
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.Rate this question:
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- 26.
What of the following actions do we take with Health Net insurance?
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Check Health Net website for eligibility
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Collect self pay fee
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Obtain prior authorization
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Call insurance
Correct Answer
A. Check Health Net website for eligibilityExplanation
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.Rate this question:
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- 27.
How much are sports physicals ?
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$100
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$45
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$75
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Insurance covers it
Correct Answer
A. $45Explanation
The correct answer is $45. This is the cost of sports physicals.Rate this question:
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- 28.
You run insurance eligibility. Eligibility states Deductible is In-Plan Network and has a remaining $870.19, Copay is Out-Of-Plan Network $35, and Coinsurance is In-Plan Network 10%. What do we collect?
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Coinsurance
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Deductible
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Out of plan network
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Copay
Correct Answer
A. DeductibleExplanation
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.Rate this question:
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- 29.
T/F: A patient has an outstanding balance (not In-Collections), and can't afford to pay it today. It is okay to see the patient and bill them later.
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True
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False
Correct Answer
A. FalseExplanation
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.Rate this question:
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- 30.
How much is the cancellation and No Show fee for Ultrasounds?
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$50
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$200
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$100
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No fee
Correct Answer
A. $200Explanation
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.Rate this question:
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- 31.
T/F: A patient comes into clinic on 8/5/18 with c/o pink eye and has an unmet deductible of $500. Receptionist collected $225 for unmet deductible. Eight days later, the same patient comes back into clinic with c/o UTI and still has an unmet deductible. We would collect another unmet deductible fee $225 again.
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True
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False
Correct Answer
A. TrueExplanation
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.Rate this question:
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- 32.
A regular health insurance patient is given an orthopedic supply. Which of the following statement is true?
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We do not collect any money for the supply.
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Inform the patient that an orthopedic supply is covered by insurance.
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Receptionst/MA informs patient that patient has pay out-of-pocket for the supply and charge accordingly to Self Pay schedule.
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Inform the patient that we will send a bill in the futuer for the orthopedic supply.
Correct Answer
A. Receptionst/MA informs patient that patient has pay out-of-pocket for the supply and charge accordingly to Self Pay schedule.Explanation
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.Rate this question:
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- 33.
At AHC, how much is an intermediate visit that has a consultation and rapid strep test?
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$100
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$130
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$150
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$75
Correct Answer
A. $130Explanation
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.Rate this question:
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- 34.
T/F: A patient comes into clinic with HMO insurance. We would continue to run the insurance eligibility, collect any fees due, and see the patient.
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True
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False
Correct Answer
A. FalseExplanation
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.Rate this question:
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- 35.
A Patient calls and asks if there is a provider onsite at the AHC clinic. How would you respond? (Select all that apply)
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Inform patient there is no provider on site
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Tell patient they will be seen by a provider virtually
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"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."
Correct Answer
A. "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."Explanation
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.Rate this question:
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- 36.
How much is the AHC Self-Pay fee?
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$225
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$100
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$75
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$200
Correct Answer
A. $100Explanation
The AHC Self-Pay fee is $100.Rate this question:
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- 37.
T/F: You have to contact the Billing Department to send medical records to the patient's Primary Care Physician.
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True
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False
Correct Answer
A. FalseExplanation
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.Rate this question:
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- 38.
What is required for a patient with Traveler's insurance? (Select all that apply)
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A form with the Authorization to treat.
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Offer self-pay
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Form of identification (Passport or DL)
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CC in Collectly
Correct Answer(s)
A. A form with the Authorization to treat.
A. Form of identification (Passport or DL)
A. CC in CollectlyExplanation
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.Rate this question:
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- 39.
At AUC, how much is a consultation + X-Ray?
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$400
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$100
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$200
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$300
Correct Answer
A. $300Explanation
The correct answer is $300. This means that at AUC, the cost of a consultation plus an X-Ray is $300.Rate this question:
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- 40.
T/F: We can accept Tricare without their physical insurance cards if they provide us with their Driver's License and primary subscriber's Social Security Number.
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True
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False
Correct Answer
A. TrueExplanation
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.Rate this question:
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- 41.
You run eligibility and it states "Out of Plan Network" for all of Deductible, Copay, and Coinsurance. What is the protocol for this situation?
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Collect CC on file, inform that we will bill their insurance first, and see patient today.
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Tell the patient they are out of network and we can't see them today.
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Charge an extra fee since the insurance is not in network with us
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Offer patient the self-pay prices
Correct Answer
A. Collect CC on file, inform that we will bill their insurance first, and see patient today.Explanation
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.Rate this question:
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- 42.
What is the insurance name and Payor ID for Anthem Blue Cross/PPO?
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PRNT1214 Anthem blue cross
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94036 Anthem blue cross
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47198 CA Anthem Blue Cross
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94036 Blue Shield of CA (Blue card)
Correct Answer
A. 47198 CA Anthem Blue CrossExplanation
The insurance name and Payor ID for Anthem Blue Cross/PPO is 47198 CA Anthem Blue Cross.Rate this question:
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- 43.
If you run across an insurance we do not see often, and Dr. Chrono won't let you run eligibility, then what should you do? (Select all that apply)
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Tell patient you cant run their insurance
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Enter payer ID and claim information based on the back of insurance card
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Collect the Copay listed on the front of card
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CC in Colleclty
Correct Answer(s)
A. Enter payer ID and claim information based on the back of insurance card
A. Collect the Copay listed on the front of card
A. CC in CollecltyExplanation
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.Rate this question:
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- 44.
In what order do we input a cash payment into Dr Chrono?
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Balance tab, Patients payments tab, Add, email Liana and CC Ops Manager
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Email Liana, Patient payments tab, Balance tab, Add, Payment method (cash)
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Add, Balance tab, Payment method (Cash), patients payments tab
Correct Answer
A. Balance tab, Patients payments tab, Add, email Liana and CC Ops ManagerExplanation
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.Rate this question:
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- 45.
A patient comes into an AUC clinic with c/o cough and is self-pay. Receptionist/MA initially charges $200 for a simple consultation up front. In the room, patient is provided with IV therapy, Nebulizer treatment, EKG testing, and medication administration. How much in addition should be charged to match for the services provided?
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$100
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$200
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$300
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$400
Correct Answer
A. $200Explanation
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.Rate this question:
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- 46.
When running eligibility on PPO, DrChrono states "Error in running eligibility" What should you do? (Select all that apply)
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Double check all insurance information is entered correctly.
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Tell patient: I can't run your insurance.
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Offer self-pay
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Collect copay IF it is listed on front of card
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CC in colleclty and bill to the insurance first if it is active insurance and there is no copay listed on the front of the card
Correct Answer(s)
A. Double check all insurance information is entered correctly.
A. Collect copay IF it is listed on front of card
A. CC in colleclty and bill to the insurance first if it is active insurance and there is no copay listed on the front of the cardExplanation
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.Rate this question:
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- 47.
A patient comes into the clinic very upset because of a bill and demands to speak to a manager or Billing Department. What will you do? [Select all that applies]
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Give patient Mangers name and phone number
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Inform your Manager and let the patient know someone will reach out to them soon.
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Give the patient our Billing's Department number
Correct Answer(s)
A. Inform your Manager and let the patient know someone will reach out to them soon.
A. Give the patient our Billing's Department number -
- 48.
What do we do if Urgent Care is stated to be "Non-Covered?"
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Inform patient the Urgent Care is not covered
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Self Pay
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Put CC on file and inform patient we will bill their insurance
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Inform patient we are out of network
Correct Answer
A. Put CC on file and inform patient we will bill their insuranceExplanation
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.Rate this question:
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- 49.
A patient walks into clinic and had just been in a motor vehicle accident. She states she is going to use her auto insurance. Her auto insurance has medical coverage. What must be collected from this patient before she can be seen? (Select all that apply)
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Claim and policy number
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Insurance company name and phone #
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Insurance agent name and phone and fax #
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DL/Photo ID
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CC in collectly
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Personal Health Insurance
Correct Answer(s)
A. Claim and policy number
A. Insurance company name and phone #
A. Insurance agent name and phone and fax #
A. DL/Photo ID
A. CC in collectly
A. Personal Health Insurance -
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Mar 20, 2023Quiz Edited by
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Jan 29, 2019Quiz Created by
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