Medical Auditing Practice Exam

What is the consequence of failing to include the assignment of benefits form in the medical record?

1. Payment will be denied entirely

2. Payment may be sent directly to the beneficiary

3. Claims will require resubmission

4. The provider will face penalties

The correct answer is: Payment may be sent directly to the beneficiary

Choosing the consequence of failing to include the assignment of benefits form in the medical record highlights the importance of understanding how such documentation affects insurance claims and provider reimbursements. When the assignment of benefits is not included, the payment may be directed to the beneficiary rather than the provider. This occurs because the assignment of benefits indicates that the patient authorizes the insurance company to pay the provider directly for the services rendered. Without this authorization, the insurance company may be compelled to send payment to the patient instead, which can lead to complications for the provider in collecting their due payment. This understanding emphasizes the necessity for providers to ensure that all relevant documentation is completed and included in the medical records, as it can significantly impact the revenue cycle and the likelihood of timely reimbursements. It is crucial for healthcare providers to establish and maintain proper documentation practices to minimize any potential disruptions in their payment processes.