Practice Management Alert

The following are examples of the types of questions iLIANT Management Directions in Winston-Salem, N.C., uses when assessing applicants for collection work. Scoring is based on a possible total of 100 points with the objective section weighing 45 points and the essay weighing 55 points. Consider 80 percent a satisfactory score for a potential employee:

Please indicate your answer by "T" for true or "F" for false: Score: 5 points each.

1. ____ Insurance companies, federal and state programs, and other third-party payers adopt different methods of basing their payments on claims.

2. ____ "Upcoding" is a term used to describe deliberate manipulation of CPT codes for increased payment.

3. ____ Bundling is coding and billing one CPT code to identify multiple-procedure codes.

Please circle the letter that best satisfies the question. Score: 5 points each.

4. Which of the following is not a valid method of insurance payment:

a. fee schedules
b. relative value scales
c. capitated estimates
d. usual, customary and reasonable
e. diagnosis-related groups

5. Which of the following is not a common reason why claims are rejected or delayed:

a. Diagnostic code is missing or incomplete and/or not in standard nomenclature
b. Diagnostic code does not correspond to the treatment rendered by the physician c. Procedure codes are incorrect, invalid or missing
d. Patient's address is incorrect
e. None of the above

1. T, 2. T, 3. T, 4. c, 5. e. Answers:

Please define the following words and describe how each relates to effective billing.

Score: 5 points each.

6. Copayment
7. Deductible
8. EOB
9. ABN

Please answer the following essay. Score: 55 points.

You are responsible for the billing and collections of a two-physician family-practice group. The group has been in business for three years and its A/R reflects the following:

Current $41,075
30 $15,287
60 $35,205
90 $22,496
120+ $10,777

No money is collected at the time of service. Insurance checks have not been posted for the last month due to backlog, and when they have been posted, they didn't balance. Charges are being input once a week, and there seems to be a backlog there also. Deposits are made on Fridays before 6 p.m., and patients frequently don't remember what type of insurance (if any) they possess.

Explain what you view as areas for improvement and what you would do to increase the profitability of this practice, decrease A/R, and provide checks and balances for reconciliations. Please be thorough.

Source: Questions reprinted with permission of iLIANT Corporation iliant.com. $ $ $