Rheumatology Coding Corner Questions: Eligibility Quiz

1. An established patient is seen in the office for a scheduled visit with the rheumatologist at the start of the new year. What should the front desk staff do for all patients at the beginning of each year?
   1. Inform the patient that their co-pay is due prior to receiving treatment, and ask how they would like to take care of it.
   2. Ask if the patient’s insurance has changed, or if they have received a new insurance card.
   3. Ask if this is a referral.
   4. Assume the patient will let you know about any changes.
2. An established patient of two years schedules his first infliximab infusion for one week from today. What should take place before the patient returns to the office for the infusion?
   1. Collect the patient’s copay or coinsurance.
   2. Inform the patient how long the procedure typically takes.
   3. Contact the insurance carrier to find out benefit guidelines (e.g., prior authorization request, benefit level).
   4. Nothing; the patient has been coming to the practice for two years.
3. A patient presents to the practice for their third infusion. Insurance eligibility does not need to be completed because benefits have already been verified at the first infusion.
   1. True
   2. False
4. The patient has two insurance plans and is scheduled for an injection of ustekinumab. Prior authorization is requested and completed with the primary insurance. Does the practice need a separate authorization for the patient’s secondary insurance?
   1. Yes
   2. No
5. Once a patient’s insurance verification is completed by the office medical staff, it is not necessary to have a prior authorization completed for the patient to receive treatment of certolizumab pegol.
   1. True
   2. False

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