Question 1

In most cases, the insured person pays an annual cost or ____ for healthcare insurance.

Accepted Answer

A)   coinsurance
B)   premium
C)   copayment
D)   capitation
E)   benefitF) C) and E)
G) C) and D)

Question 2

To be covered under Medicare Part B, patients must ____.

Accepted Answer

A)   remain in the hospital for more than 90 days
B)   receive medical care at home
C)   purchase private insurance
D)   enroll, because coverage is not automatic
E)   be terminally illF) A) and B)
G) A) and C)

Question 3

The ________ charge is the maximum charge that the payer will pay a provider for a particular procedure or service.

Accepted Answer

allowedall...

Question 4

Using a clearinghouse to transmit electronic media claims ____.

Accepted Answer

A)   makes more paperwork than paper claims
B)   requires a greater amount of time to process claims
C)   includes data elements that are transmitted in a computer file.
D)   enables a 30-day turnaround time from submission to payment
E)   requires a translator and technology to conduct electronic data interchangeF) A) and E)
G) A) and D)

Question 5

An appropriate approach to maintaining patient confidentiality on the computer is to ____.

Accepted Answer

A)   make sure a coworker knows your password in case you are sick
B)   allow former employees to keep their passwords
C)   change your password every 90 days
D)   provide each patient with a unique password
E)   send confidential information only by fax, never by computerF) B) and D)
G) B) and E)

Question 6

Who most frequently files insurance claims and handles insurers' payments for a medical practice?

Accepted Answer

A)   Patient
B)   Nurse
C)   Medical assistant
D)   Physician
E)   Physician assistantF) C) and D)
G) B) and E)

Question 7

A health plan provides ________, which are the payments for medical services provided to the patient.

Accepted Answer

The answer of A health plan provides ________, which are...

Question 8

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) A) and B)
G) A) and C)

Question 9

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 10

Insurance carriers perform a review for medical ________ on each claim to determine whether the treatment is needed for the diagnosis listed.

Accepted Answer

The answer of Insurance carriers perform a review for medical...

Question 11

An organization that provides pain relief to terminally ill patients and supports these patients and their families is a ____.

Accepted Answer

A)   respite
B)   hospital
C)   outpatient clinic
D)   rehabilitation center
E)   hospiceF) B) and C)
G) A) and B)

Question 12

The ________ payer is the health plan that pays for medical services.

Accepted Answer

third-part...

Question 13

If your office submits paper claims, you should create and maintain a claims ________ to track the progress of submitted claims.

Accepted Answer

The answer of If your office submits paper claims, you...

Question 14

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 15

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) B) and D)

Question 16

When a physician agrees to accept assignment for a Medicare patient, this means the physician ____.

Accepted Answer

A)   bills Medicare for the cost of service not covered by Medicaid
B)   will accept Medicare but not Medicaid patients
C)   will accept the amount of money Medicaid pays as payment in full
D)   will accept only emergency patients covered by Medicaid
E)   bills the patient for the cost of service not covered by MedicareF) A) and E)
G) A) and C)

Question 17

An insurance claims department compares the fee the doctor charges with the benefits provided by the patient's health plan. This is called the ____.

Accepted Answer

A)   payment of benefits
B)   review of medical necessity
C)   explanation of benefits
D)   review for allowable benefits
E)   payment and remittance adviceF) All of the above
G) A) and D)

Question 18

Insurers include either an explanation of payment or a(n) ________ advice along with payment to the practice or to the patient, depending on whether an assignment of benefits was signed.

Accepted Answer

The answer of Insurers include either an explanation of payment...

Question 19

The usual fees that are listed on the medical office's fee schedule are fees ____.

Accepted Answer

A)   paid by the third-party provider
B)   charged over what most third-party payers will pay
C)   charged to most of their patients most of the time under typical conditions
D)   charged as a professional courtesy
E)   charged only to patients who have private insuranceF) A) and B)
G) A) and E)

Question 20

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...

Exam 17: Insurance and Billing

Insurers include either an explanation of payment or a(n) ________ advice along with payment to the practice or to the patient, depending on whether an assignment of benefits was signed.

Correct AnswerverifiedShow Answer

Who most frequently files insurance claims and handles insurers' payments for a medical practice?

Correct AnswerverifiedShow Answer

Insurance carriers perform a review for medical ________ on each claim to determine whether the treatment is needed for the diagnosis listed.

Correct AnswerverifiedShow Answer

In most cases, the insured person pays an annual cost or ____ for healthcare insurance.

Correct AnswerverifiedShow Answer

The ________ payer is the health plan that pays for medical services.

Correct Answerverifiedthird-part...View AnswerShow Answer

A health plan provides ________, which are the payments for medical services provided to the patient.

Correct AnswerverifiedShow Answer

If your office submits paper claims, you should create and maintain a claims ________ to track the progress of submitted claims.

Correct AnswerverifiedShow Answer

Using a clearinghouse to transmit electronic media claims ____.

Correct AnswerverifiedShow Answer

When a physician agrees to accept assignment for a Medicare patient, this means the physician ____.

Correct AnswerverifiedShow Answer

The usual fees that are listed on the medical office's fee schedule are fees ____.

Correct AnswerverifiedShow Answer

An appropriate approach to maintaining patient confidentiality on the computer is to ____.

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

An organization that provides pain relief to terminally ill patients and supports these patients and their families is a ____.

Correct AnswerverifiedShow Answer

One advantage of submitting claims electronically is ____.

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

An insurance claims department compares the fee the doctor charges with the benefits provided by the patient's health plan. This is called the ____.

Correct AnswerverifiedShow Answer

To be covered under Medicare Part B, patients must ____.

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

The ________ charge is the maximum charge that the payer will pay a provider for a particular procedure or service.

Correct Answerverifiedallowedall...View AnswerShow Answer

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified
third-part...
View Answer

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified
allowedall...
View Answer