Question 1

________ is the act of processing a claim that consists of edits, review, and determination.

Accepted Answer

The answer of ________ is the act of processing a...

Question 2

EOB notifications are issued in the same format by all insurance carriers.

Accepted Answer

A) True 
 B)False

Question 3

It is not unusual for an annual deductible to be as high as:

Accepted Answer

A)  $500-$1,000. 
B)  $1,000-$2,500. 
C)  $2,000-$5,000. 
D)  $5,000-$8,000. 
A)  $500-$1,000. 
B)  $1,000-$2,500. 
C)  $2,000-$5,000. 
D)  $5,000-$8,000.

Question 4

What types of costs are included in a patient's out-of-pocket expenses?

Accepted Answer

Out-of-pocket expenses include any deduc

Question 5

The resource-based fee structure takes into account the provider's work, the practice expense, and the cost of professional liability insurance.

Accepted Answer

A) True 
 B)False

Question 6

Which three factors are considered in determining resource-based fee structures?

Accepted Answer

The three factors considered a

Question 7

The deductible under most insurance plans applies to each covered individual each:

Accepted Answer

A)  date of service. 
B)  month. 
C)  calendar year. 
D)  contract. 
A)  date of service. 
B)  month. 
C)  calendar year. 
D)  contract.

Question 8

An appeal for reconsideration of a carrier's decision on a claim must be made:

Accepted Answer

A)  online. 
B)  in writing. 
C)  by phone and in writing. 
D)  with the help of an attorney. 
A)  online. 
B)  in writing. 
C)  by phone and in writing. 
D)  with the help of an attorney.

Question 9

Match the following

-Version of the EOB sent to the provider by the insurance carrier after the processing of electronic claims

Accepted Answer

A)  deductible 
B)  electronic remittance advice (ER
A)  
C)  conversion factor 
D)  coinsurance 
E)  relative value unit
F) reason code
G) adjudication
H) copayment
I) withhold
J) allowed charge 
A)  deductible 
B)  electronic remittance advice (ER
A)  
C)  conversion factor 
D)  coinsurance 
E)  relative value unit
F) reason code
G) adjudication
H) copayment
I) withhold
J) allowed charge

Question 10

The section of the EOB that indicates who was paid, how much, and when is the:

Accepted Answer

A)  service information. 
B)  coverage determination. 
C)  benefit payment information. 
D)  summary information. 
A)  service information. 
B)  coverage determination. 
C)  benefit payment information. 
D)  summary information.

Question 11

The set amount a patient must pay at the time of service is the:

Accepted Answer

A)  coinsurance. 
B)  copayment. 
C)  deductible. 
D)  premium. 
A)  coinsurance. 
B)  copayment. 
C)  deductible. 
D)  premium.

Question 12

When the practice receives the EOBs and documentation of deposit from the lockbox, the office insurance specialist should: (Select all that apply)

Accepted Answer

A)  add up the EOBs to ensure that the total equals the company's check. 
B)  consider "batching" the EOBs if there are a lot of them. 
C)  call the bank to ensure all EOBs are accounted for in the case of a discrepancy. 
D)  all of the above. 
A)  add up the EOBs to ensure that the total equals the company's check. 
B)  consider "batching" the EOBs if there are a lot of them. 
C)  call the bank to ensure all EOBs are accounted for in the case of a discrepancy. 
D)  all of the above.

Question 13

In regard to the RBRVS system, the risk of harm posed to the patient by a particular service or procedure is considered to be part of the:

Accepted Answer

A)  provider's effort and stress level. 
B)  practice expense. 
C)  cost of liability insurance. 
D)  risk factor for a given specialty. 
A)  provider's effort and stress level. 
B)  practice expense. 
C)  cost of liability insurance. 
D)  risk factor for a given specialty.

Question 14

The largest cost element in determining the nationally uniform relative value of a service is the:

Accepted Answer

A)  provider's work. 
B)  practice expense. 
C)  cost of professional liability insurance. 
D)  location of the practice. 
A)  provider's work. 
B)  practice expense. 
C)  cost of professional liability insurance. 
D)  location of the practice.

Question 15

In regard to the RBRVS system, the overhead of a physician's office is referred to as the:

Accepted Answer

A)  provider's work. 
B)  practice expense. 
C)  professional liability insurance. 
D)  payroll expense. 
A)  provider's work. 
B)  practice expense. 
C)  professional liability insurance. 
D)  payroll expense.

Question 16

When treatment is determined to be appropriate for the diagnosis, the care is considered:

Accepted Answer

A)  medically necessary. 
B)  medically appropriate. 
C)  medically reasonable. 
D)  medically feasible. 
A)  medically necessary. 
B)  medically appropriate. 
C)  medically reasonable. 
D)  medically feasible.

Question 17

A patient is expected to pay for services excluded from his or her insurance policy at the time the service is rendered.

Accepted Answer

A) True 
 B)False

Question 18

Match the following

-Percentage of the provider's payment held back to offset any additional costs under a capitation agreement

Accepted Answer

A)  deductible 
B)  electronic remittance advice (ER
A)  
C)  conversion factor 
D)  coinsurance 
E)  relative value unit
F) reason code
G) adjudication
H) copayment
I) withhold
J) allowed charge 
A)  deductible 
B)  electronic remittance advice (ER
A)  
C)  conversion factor 
D)  coinsurance 
E)  relative value unit
F) reason code
G) adjudication
H) copayment
I) withhold
J) allowed charge

Question 19

Coinsurance refers to:

Accepted Answer

A)  the amount a patient must pay each year before benefits begin. 
B)  a set amount a patient must pay at the time of service. 
C)  a percentage of allowable charges the patient must pay. 
D)  the amount of out-of-pocket expenses a patient must pay. 
A)  the amount a patient must pay each year before benefits begin. 
B)  a set amount a patient must pay at the time of service. 
C)  a percentage of allowable charges the patient must pay. 
D)  the amount of out-of-pocket expenses a patient must pay.

Question 20

In regard to the RBRVS system, the time it takes to perform a service is considered to be part of the:

Accepted Answer

A)  provider's work. 
B)  practice expense. 
C)  time factor. 
D)  staff expense. 
A)  provider's work. 
B)  practice expense. 
C)  time factor. 
D)  staff expense.

________ is the act of processing a claim that consists of edits, review, and determination.

EOB notifications are issued in the same format by all insurance carriers.

It is not unusual for an annual deductible to be as high as:

What types of costs are included in a patient's out-of-pocket expenses?

The resource-based fee structure takes into account the provider's work, the practice expense, and the cost of professional liability insurance.

Which three factors are considered in determining resource-based fee structures?

The deductible under most insurance plans applies to each covered individual each:

An appeal for reconsideration of a carrier's decision on a claim must be made:

Match the following -Version of the EOB sent to the provider by the insurance carrier after the processing of electronic claims

The section of the EOB that indicates who was paid, how much, and when is the:

The set amount a patient must pay at the time of service is the:

When the practice receives the EOBs and documentation of deposit from the lockbox, the office insurance specialist should: (Select all that apply)

In regard to the RBRVS system, the risk of harm posed to the patient by a particular service or procedure is considered to be part of the:

The largest cost element in determining the nationally uniform relative value of a service is the:

In regard to the RBRVS system, the overhead of a physician's office is referred to as the:

When treatment is determined to be appropriate for the diagnosis, the care is considered:

A patient is expected to pay for services excluded from his or her insurance policy at the time the service is rendered.

Match the following -Percentage of the provider's payment held back to offset any additional costs under a capitation agreement

Coinsurance refers to:

In regard to the RBRVS system, the time it takes to perform a service is considered to be part of the:

Introduction to Professional Billing and Coding Careers

Understanding Managed Care: Insurance Plans

Understanding Managed Care: Medical Contracts and Ethics

Introduction to the Health Insurance Portability and Accountability Act Hipaa

ICD-10 Cm Medical Coding

Introduction to CPT and Place of Coding Services

Coding Procedures and Services

Hcpcs Coding and Compliance

Auditing

Physician Medical Billing

Hospital Medical Billing

Medicare Medical Billing

Medicaid Medical Billing

Tricare Medical Billing

Refunds and Appeals

Workers Compensation

Filters

Exam 15: Explanation of Benefits and Payment Adjudication

________ is the act of processing a claim that consists of edits, review, and determination.

EOB notifications are issued in the same format by all insurance carriers.

It is not unusual for an annual deductible to be as high as:

What types of costs are included in a patient's out-of-pocket expenses?

The resource-based fee structure takes into account the provider's work, the practice expense, and the cost of professional liability insurance.

Which three factors are considered in determining resource-based fee structures?

The deductible under most insurance plans applies to each covered individual each:

An appeal for reconsideration of a carrier's decision on a claim must be made:

Match the following -Version of the EOB sent to the provider by the insurance carrier after the processing of electronic claims

The section of the EOB that indicates who was paid, how much, and when is the:

The set amount a patient must pay at the time of service is the:

When the practice receives the EOBs and documentation of deposit from the lockbox, the office insurance specialist should: (Select all that apply)

In regard to the RBRVS system, the risk of harm posed to the patient by a particular service or procedure is considered to be part of the:

The largest cost element in determining the nationally uniform relative value of a service is the:

In regard to the RBRVS system, the overhead of a physician's office is referred to as the:

When treatment is determined to be appropriate for the diagnosis, the care is considered:

A patient is expected to pay for services excluded from his or her insurance policy at the time the service is rendered.

Match the following -Percentage of the provider's payment held back to offset any additional costs under a capitation agreement

Coinsurance refers to:

In regard to the RBRVS system, the time it takes to perform a service is considered to be part of the:

Introduction to Professional Billing and Coding Careers

Understanding Managed Care: Insurance Plans

Understanding Managed Care: Medical Contracts and Ethics

Introduction to the Health Insurance Portability and Accountability Act Hipaa

ICD-10 Cm Medical Coding

Introduction to CPT and Place of Coding Services

Coding Procedures and Services

Hcpcs Coding and Compliance

Auditing

Physician Medical Billing

Hospital Medical Billing

Medicare Medical Billing

Medicaid Medical Billing

Tricare Medical Billing

Refunds and Appeals

Workers Compensation

Filters