Question 1

A husband and wife are both employed and have work-sponsored insurance plans that cover each other and their three children. Which insurance plan is the primary payer?

Accepted Answer

A)   The husband's insurance plan, because he makes more money
B)   The insurance plan of the person whose birthday comes first in the calendar year
C)   The wife's insurance plan, because it has the most comprehensive coverage
D)   Whichever the husband and wife want to declare as primary
E)   The insurance plan of the person whose policy went into effect firstF) B) and C)
G) A) and B)

Question 2

One advantage of submitting claims electronically is ____.

Accepted Answer

A)   it increases the time between submission and payment
B)   patients can submit their own claims easily
C)   electronic claims cannot be rejected
D)   the practice can receive larger payments
E)   electronic submissions are cost-efficientF) A) and D)
G) A) and C)

Question 3

The payment system used by Medicare is based on ____.

Accepted Answer

A)   prevailing rates in the region
B)   resources
C)   the price of medical equipment used
D)   fee-for-service agreements
E)   the physicians' minimum chargesF) D) and E)
G) A) and B)

Question 4

Federal law requires employers to purchase and maintain a certain minimum amount of workers' ________ insurance for their employees.

Accepted Answer

The answer of Federal law requires employers to purchase and...

Question 5

Of the federal programs providing healthcare, the largest is ____, which provides health insurance for citizens aged 65 and older.

Accepted Answer

A)   Medicaid
B)   Medicare
C)   disability insurance
D)   liability insurance
E)   CHAMPVAF) A) and D)
G) C) and D)

Question 6

What percent of the allowable fee does Medicare pay the healthcare provider after the annual deductible is met?

Accepted Answer

A)   20%
B)   50%
C)   75%
D)   80%
E)   100%F) D) and E)
G) None of the above

Question 7

A small fee that is collected at the time of service is called a(n) _______.

Accepted Answer

The answer of A small fee that is collected at...

Question 8

A(n) "________" healthcare claim is one that is error-free and is accepted for processing by the payer.

Accepted Answer

The answer of A(n) "________" healthcare claim is one that...

Question 9

Legal clauses in insurance policies that prevent duplication of payment are called ________ of benefits clauses.

Accepted Answer

The answer of Legal clauses in insurance policies that prevent...

Question 10

The person whose name the insurance is carried under is called the ____.

Accepted Answer

A)   carrier
B)   subscriber
C)   coinsurer
D)   provider
E)   third partyF) B) and E)
G) A) and B)

Question 11

The payment system used by ________ is called the resource-based relative value scale (RBRVS).

Accepted Answer

The answer of The payment system used by ________ is...

Question 12

Patients who belong to a managed care health plan, such as an HMO, are responsible for a small per-visit fee collected at the time of the visit. This fee is commonly called a(n)  ____.

Accepted Answer

A)   copayment
B)   premium
C)   coinsurance
D)   capitation
E)   deductibleF) C) and D)
G) None of the above

Question 13

Which of the following is not part of the process for verifying workers' compensation coverage?

Accepted Answer

A)   Getting the name and policy number of the patient's personal health insurance policy
B)   Obtaining the employer's verification that the accident was work-related
C)   Asking the verifier at the patient's company for the original date of the injury
D)   Getting the name of the verifier at the patient's company
E)   Asking if the company has opened a worker's compensation case with the insurance companyF) B) and D)
G) D) and E)

Question 14

The process of deciding the amount of money that will be paid by a third-party payer for a procedure is ____.

Accepted Answer

A)   preauthorization
B)   copayment
C)   precertification
D)   deductible
E)   predeterminationF) A) and E)
G) C) and D)

Question 15

Which of the following is correct regarding electronic claim submissions?

Accepted Answer

A)   Claims cannot be transmitted directly by electronic data interchange (EDI) .
B)   Claims cannot be entered into the health plan's computer system.
C)   Clearinghouses will modify data as necessary to ensure a standard format.
D)   Claims are prepared for transmission after all required data elements have been entered.
E)   Claim submissions cannot be integrated with EHR systems.F) C) and E)
G) C) and D)

Question 16

Eligibility for Medicaid is ____.

Accepted Answer

A)   automatic for patients aged 65 and older
B)   based on the patient's reported income and assets from the previous month
C)   based on the patient's reported income and assets from the previous year
D)   based on the patient's reported income and assets for the previous three months
E)   based on the patient's reported income and assets for the previous six monthsF) D) and E)
G) B) and D)

Question 17

A(n) ________ procedure is a medical procedure that is not required to sustain life and that is planned in advance to be done at the convenience of the physician or surgeon and the patient.

Accepted Answer

The answer of A(n) ________ procedure is a medical procedure...

Question 18

The ________ is the annual payment made to an insurance company by the patient to keep the insurance policy in effect.

Accepted Answer

The answer of The ________ is the annual payment made...

Question 19

The ________ is a fixed amount that must be paid by the policyholder each year before a third-party payer begins to cover medical expenses.

Accepted Answer

The answer of The ________ is a fixed amount that...

Question 20

In a typical medical practice, insurance claims are filed ____.

Accepted Answer

A)   the day before the filing limit is reached
B)   the day before the date of service
C)   a few business days after the date of service
D)   9 months after the service is rendered
E)   1 year from the date of serviceF) B) and C)
G) A) and E)

Exam 17: Insurance Billing

Which of the following is correct regarding electronic claim submissions?

Correct AnswerverifiedShow Answer

One advantage of submitting claims electronically is ____.

Correct AnswerverifiedShow Answer

The person whose name the insurance is carried under is called the ____.

Correct AnswerverifiedShow Answer

Patients who belong to a managed care health plan, such as an HMO, are responsible for a small per-visit fee collected at the time of the visit. This fee is commonly called a(n) ____.

Correct AnswerverifiedShow Answer

What percent of the allowable fee does Medicare pay the healthcare provider after the annual deductible is met?

Correct AnswerverifiedShow Answer

The ________ is the annual payment made to an insurance company by the patient to keep the insurance policy in effect.

Correct AnswerverifiedShow Answer

A(n) "________" healthcare claim is one that is error-free and is accepted for processing by the payer.

Correct AnswerverifiedShow Answer

In a typical medical practice, insurance claims are filed ____.

Correct AnswerverifiedShow Answer

A husband and wife are both employed and have work-sponsored insurance plans that cover each other and their three children. Which insurance plan is the primary payer?

Correct AnswerverifiedShow Answer

Eligibility for Medicaid is ____.

Correct AnswerverifiedShow Answer

A small fee that is collected at the time of service is called a(n) _______.

Correct AnswerverifiedShow Answer

The process of deciding the amount of money that will be paid by a third-party payer for a procedure is ____.

Correct AnswerverifiedShow Answer

The payment system used by ________ is called the resource-based relative value scale (RBRVS).

Correct AnswerverifiedShow Answer

The payment system used by Medicare is based on ____.

Correct AnswerverifiedShow Answer

Of the federal programs providing healthcare, the largest is ____, which provides health insurance for citizens aged 65 and older.

Correct AnswerverifiedShow Answer

A(n) ________ procedure is a medical procedure that is not required to sustain life and that is planned in advance to be done at the convenience of the physician or surgeon and the patient.

Correct AnswerverifiedShow Answer

Which of the following is not part of the process for verifying workers' compensation coverage?

Correct AnswerverifiedShow Answer

The ________ is a fixed amount that must be paid by the policyholder each year before a third-party payer begins to cover medical expenses.

Correct AnswerverifiedShow Answer

Federal law requires employers to purchase and maintain a certain minimum amount of workers' ________ insurance for their employees.

Correct AnswerverifiedShow Answer

Legal clauses in insurance policies that prevent duplication of payment are called ________ of benefits clauses.

Correct AnswerverifiedShow Answer

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