Question 1

What forms of identification should be requested to verify a patient's identity?

Accepted Answer

Acceptable forms of identifica

Question 2

If the reported services are deemed NOT medically necessary at the level reported, the claim will be:

Accepted Answer

A)  denied. 
B)  downcoded. 
C)  upcoded. 
D)  pended. 
A)  denied. 
B)  downcoded. 
C)  upcoded. 
D)  pended.

Question 3

The physician's work element accounts for what percentage of the total relative value for each service?

Accepted Answer

A)  25% 
B)  32% 
C)  52% 
D)  75% 
A)  25% 
B)  32% 
C)  52% 
D)  75%

Question 4

Reason and remark codes are explained on the face or back of the EOB/ERA.

Accepted Answer

A) True 
 B)False

Question 5

A(n) ________ claim is one that has been received by the carrier but cannot be processed due to an error or because additional information is needed.

Accepted Answer

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

Question 6

Under an 80/20 plan, if a participating provider's usual charge is $200 for a procedure and the allowed amount is $150, the provider can collect:

Accepted Answer

A)  $150 from the insurance carrier and $50 from the patient. 
B)  $120 from the insurance carrier and $30 from the patient. 
C)  $120 from the insurance carrier and $80 from the patient. 
D)  $160 from the insurance carrier and $40 from the patient. 
A)  $150 from the insurance carrier and $50 from the patient. 
B)  $120 from the insurance carrier and $30 from the patient. 
C)  $120 from the insurance carrier and $80 from the patient. 
D)  $160 from the insurance carrier and $40 from the patient.

Question 7

Match the following

-The maximum amount an insurance carrier will pay for a covered service

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 8

The allowed charge includes the amount that will be paid by:

Accepted Answer

A)  the insurance carrier only. 
B)  the patient only. 
C)  the insurance carrier and the patient. 
D)  none of the above. 
A)  the insurance carrier only. 
B)  the patient only. 
C)  the insurance carrier and the patient. 
D)  none of the above.

Question 9

The RBRVS system unit of measurement assigned to a service based on the relative skill and time required to perform it is the ________ unit.

Accepted Answer

The answer of The RBRVS system unit of measurement assigned...

Question 10

What is a reason code used on an EOB?

Accepted Answer

The adjustment reason codes on

Question 11

A claim that is manually reviewed by an insurance carrier can be denied for lack of required preauthorization.

Accepted Answer

A) True 
 B)False

Question 12

A provider's usual charge for a procedure or service can be:

Accepted Answer

A)  higher than the allowed charge. 
B)  lower than the allowed charge. 
C)  equal to the allowed charge. 
D)  all of the above. 
A)  higher than the allowed charge. 
B)  lower than the allowed charge. 
C)  equal to the allowed charge. 
D)  all of the above.

Question 13

Seventy-five percent of the physician's work value under the RBRVS is adjusted by geographic cost differences.

Accepted Answer

A) True 
 B)False

Question 14

What percentage of a physician's work value is adjusted based on geographic cost differences?

Accepted Answer

A)  25% 
B)  45% 
C)  55% 
D)  75% 
A)  25% 
B)  45% 
C)  55% 
D)  75%

Question 15

A positive or negative change to a patient's account balance is a(n) ________.

Accepted Answer

The answer of A positive or negative change to a...

Question 16

If a carrier downcodes a claim and the provider maintains that the reported services were medically necessary, the medical office specialist should:

Accepted Answer

A)  send a bill to the patient for the remaining balance. 
B)  write off the remaining balance. 
C)  file an appeal with the insurance carrier. 
D)  send a complaint to the state insurance commissioner. 
A)  send a bill to the patient for the remaining balance. 
B)  write off the remaining balance. 
C)  file an appeal with the insurance carrier. 
D)  send a complaint to the state insurance commissioner.

Question 17

What is meant by verifying medical necessity when reviewing a claim?

Accepted Answer

The diagnosis and procedures a

Question 18

Electronic funds transfer (EFT) is more costly to the practice than depositing checks.

Accepted Answer

A) True 
 B)False

Question 19

Medical necessity reduction by an insurance carrier is also known as ________.

Accepted Answer

The answer of Medical necessity reduction by an insurance carrier...

Question 20

A patient's out-of-pocket expenses include deductibles, coinsurance, and copayments.

Accepted Answer

A) True 
 B)False

What forms of identification should be requested to verify a patient's identity?

If the reported services are deemed NOT medically necessary at the level reported, the claim will be:

The physician's work element accounts for what percentage of the total relative value for each service?

Reason and remark codes are explained on the face or back of the EOB/ERA.

A(n) ________ claim is one that has been received by the carrier but cannot be processed due to an error or because additional information is needed.

Under an 80/20 plan, if a participating provider's usual charge is $200 for a procedure and the allowed amount is $150, the provider can collect:

Match the following -The maximum amount an insurance carrier will pay for a covered service

The allowed charge includes the amount that will be paid by:

The RBRVS system unit of measurement assigned to a service based on the relative skill and time required to perform it is the ________ unit.

What is a reason code used on an EOB?

A claim that is manually reviewed by an insurance carrier can be denied for lack of required preauthorization.

A provider's usual charge for a procedure or service can be:

Seventy-five percent of the physician's work value under the RBRVS is adjusted by geographic cost differences.

What percentage of a physician's work value is adjusted based on geographic cost differences?

A positive or negative change to a patient's account balance is a(n) ________.

If a carrier downcodes a claim and the provider maintains that the reported services were medically necessary, the medical office specialist should:

What is meant by verifying medical necessity when reviewing a claim?

Electronic funds transfer (EFT) is more costly to the practice than depositing checks.

Medical necessity reduction by an insurance carrier is also known as ________.

A patient's out-of-pocket expenses include deductibles, coinsurance, and copayments.

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

What forms of identification should be requested to verify a patient's identity?

If the reported services are deemed NOT medically necessary at the level reported, the claim will be:

The physician's work element accounts for what percentage of the total relative value for each service?

Reason and remark codes are explained on the face or back of the EOB/ERA.

A(n) ________ claim is one that has been received by the carrier but cannot be processed due to an error or because additional information is needed.

Under an 80/20 plan, if a participating provider's usual charge is $200 for a procedure and the allowed amount is $150, the provider can collect:

Match the following -The maximum amount an insurance carrier will pay for a covered service

The allowed charge includes the amount that will be paid by:

The RBRVS system unit of measurement assigned to a service based on the relative skill and time required to perform it is the ________ unit.

What is a reason code used on an EOB?

A claim that is manually reviewed by an insurance carrier can be denied for lack of required preauthorization.

A provider's usual charge for a procedure or service can be:

Seventy-five percent of the physician's work value under the RBRVS is adjusted by geographic cost differences.

What percentage of a physician's work value is adjusted based on geographic cost differences?

A positive or negative change to a patient's account balance is a(n) ________.

If a carrier downcodes a claim and the provider maintains that the reported services were medically necessary, the medical office specialist should:

What is meant by verifying medical necessity when reviewing a claim?

Electronic funds transfer (EFT) is more costly to the practice than depositing checks.

Medical necessity reduction by an insurance carrier is also known as ________.

A patient's out-of-pocket expenses include deductibles, coinsurance, and copayments.

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