Question 1

Claims that are done by direct billing first go to a clearinghouse.

Accepted Answer

A) True 
 B)False

Question 2

Patient care approached from a holistic approach defines

Accepted Answer

A)  Health Maintenance Organizations. 
B)  Patient-Centered Medical Home. 
C)  precertification. 
D)  medical necessity. 
A)  Health Maintenance Organizations. 
B)  Patient-Centered Medical Home. 
C)  precertification. 
D)  medical necessity.

Question 3

Which of the following is typically documented in the explanation of benefits (EOB)?

Accepted Answer

A)  Patient's deductible 
B)  Co-insurance 
C)  Copayment 
D)  Both A and B 
E)  All of the above 
A)  Patient's deductible 
B)  Co-insurance 
C)  Copayment 
D)  Both A and B 
E)  All of the above

Question 4

The insured's name is found in block

Accepted Answer

A)  1. 
B)  2. 
C)  3. 
D)  4. 
A)  1. 
B)  2. 
C)  3. 
D)  4.

Question 5

A claim that is missing information and is returned to the provider for correction and resubmission is called a(n) __________ claim.

Accepted Answer

A)  clean 
B)  dirty 
C)  dingy 
D)  incomplete 
A)  clean 
B)  dirty 
C)  dingy 
D)  incomplete

Question 6

The patient billing record includes which of the following information?

Accepted Answer

A)  Insurance billing information 
B)  Diagnostic information 
C)  Procedural information 
D)  Medication information 
A)  Insurance billing information 
B)  Diagnostic information 
C)  Procedural information 
D)  Medication information

Question 7

Block 1 of the CMS-1500 contains what information?

Accepted Answer

A)  Patient's name 
B)  Insured's name 
C)  Type of insurance coverage 
D)  Carrier address 
A)  Patient's name 
B)  Insured's name 
C)  Type of insurance coverage 
D)  Carrier address

Question 8

Insurance information should be collected on the first visit.

Accepted Answer

A) True 
 B)False

Question 9

The National Provider Identifier is assigned by the AMA.

Accepted Answer

A) True 
 B)False

Question 10

The provider is paid a set amount for each enrolled person assigned to them, per period of time, whether or not that person has received services is the definition of

Accepted Answer

A)  eligibility. 
B)  precertification. 
C)  medical necessity. 
D)  capitation. 
A)  eligibility. 
B)  precertification. 
C)  medical necessity. 
D)  capitation.

Exam 26: Billing and Reimbursement

Claims that are done by direct billing first go to a clearinghouse.

Patient care approached from a holistic approach defines

Which of the following is typically documented in the explanation of benefits (EOB)?

The insured's name is found in block

A claim that is missing information and is returned to the provider for correction and resubmission is called a(n) __________ claim.

The patient billing record includes which of the following information?

Block 1 of the CMS-1500 contains what information?

Insurance information should be collected on the first visit.

The National Provider Identifier is assigned by the AMA.

The provider is paid a set amount for each enrolled person assigned to them, per period of time, whether or not that person has received services is the definition of

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