Question 1

The steps that result in an insurance carrier's decision to either pay or deny a claim are known as:

Accepted Answer

A)  allocation. 
B)  adjudication. 
C)  determination. 
D)  justification. 
A)  allocation. 
B)  adjudication. 
C)  determination. 
D)  justification.

Question 2

Claims processing involves the verification of medical necessity for the reported procedures; this task is performed by:

Accepted Answer

A)  medical office specialists. 
B)  medical directors. 
C)  medical review examiners. 
D)  automated claims processors. 
A)  medical office specialists. 
B)  medical directors. 
C)  medical review examiners. 
D)  automated claims processors.

Question 3

Match the following

-A number used to multiply or divide a quantity when converting from one system of units to another

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 4

The notification sent by the insurance carrier to the patient and provider after a claim has been processed is known as a(n):

Accepted Answer

A)  patient registration form. 
B)  encounter form. 
C)  charge slip. 
D)  explanation of benefits. 
A)  patient registration form. 
B)  encounter form. 
C)  charge slip. 
D)  explanation of benefits.

Question 5

During the patient's care, all procedures and tests are documented on the:

Accepted Answer

A)  encounter form. 
B)  explanation of benefits. 
C)  claim form. 
D)  registration form. 
A)  encounter form. 
B)  explanation of benefits. 
C)  claim form. 
D)  registration form.

Question 6

Match the following

-The act of processing a claim that consists of edits, review, and determination.

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 7

A claim that is removed from a payer's automated processing system for additional review is subject to:

Accepted Answer

A)  preauthorization. 
B)  manual review. 
C)  medical-necessity examination. 
D)  claims edit. 
A)  preauthorization. 
B)  manual review. 
C)  medical-necessity examination. 
D)  claims edit.

Question 8

The patient is responsible for the difference between the provider's usual charge and the carrier's allowed charge when services are received from a participating provider.

Accepted Answer

A) True 
 B)False

Question 9

If a claim is denied, what process can be followed to request that the carrier reconsider the decision?

Accepted Answer

The medical office specialist should fil

Question 10

Participating providers can demand payment in full from the patient rather than waiting for the insurance carrier to process the claim.

Accepted Answer

A) True 
 B)False

Question 11

The benefit payment information on an EOB indicates who was paid, how much, and when.

Accepted Answer

A) True 
 B)False

Question 12

A lockbox service provided by a bank helps control receivables by collecting and depositing carrier and patient payments faster than if the process were performed by office staff.

Accepted Answer

A) True 
 B)False

Question 13

Under Medicare Part B, reimbursement to a participating provider is based on:

Accepted Answer

A)  80% payment by Medicare and 20% by the patient after a deductible. 
B)  20% payment by Medicare and 80% by the patient after a deductible. 
C)  80% payment by Medicare and 20% by the patient without a deductible. 
D)  20% payment by Medicare and 80% by the patient without a deductible. 
A)  80% payment by Medicare and 20% by the patient after a deductible. 
B)  20% payment by Medicare and 80% by the patient after a deductible. 
C)  80% payment by Medicare and 20% by the patient without a deductible. 
D)  20% payment by Medicare and 80% by the patient without a deductible.

Question 14

What is the benefit specified in an insurance policy that is different from out-of-pocket expenses because once the stated maximum has been met for a lifetime, no more benefits will be paid?

Accepted Answer

A)  lifetime maximum 
B)  lifelong maximum 
C)  maximum benefits 
D)  existence benefits 
A)  lifetime maximum 
B)  lifelong maximum 
C)  maximum benefits 
D)  existence benefits

Question 15

Before the Omnibus Budget Reconciliation Act (OBRA) of 1989, Medicare payments to providers were based on:

Accepted Answer

A)  the resources used to perform the procedure or services. 
B)  a Medicare-developed reasonable fee schedule. 
C)  physicians' charge-based fees. 
D)  a capitation arrangement. 
A)  the resources used to perform the procedure or services. 
B)  a Medicare-developed reasonable fee schedule. 
C)  physicians' charge-based fees. 
D)  a capitation arrangement.

Question 16

The National uniform conversion factor is updated annually by:

Accepted Answer

A)  independent insurance carriers. 
B)  the Centers for Medicare and Medicaid Services (CMS). 
C)  the legislature. 
D)  the Federal Register. 
A)  independent insurance carriers. 
B)  the Centers for Medicare and Medicaid Services (CMS). 
C)  the legislature. 
D)  the Federal Register.

Question 17

The amount of time it takes for the insurance carrier to process a claim is called the ________ time.

Accepted Answer

The answer of The amount of time it takes for...

Question 18

Match the following

-The amount that a policyholder must pay for covered services before insurance benefits begin to pay

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

In regard to the RBRVS system, the technical skill of the provider is considered to be part of the:

Accepted Answer

A)  provider's work. 
B)  practice expense. 
C)  provider's training. 
D)  malpractice risk. 
A)  provider's work. 
B)  practice expense. 
C)  provider's training. 
D)  malpractice risk.

Question 20

State and federal regulations determine how long patient records must be kept and stored.

Accepted Answer

A) True 
 B)False

The steps that result in an insurance carrier's decision to either pay or deny a claim are known as:

Claims processing involves the verification of medical necessity for the reported procedures; this task is performed by:

Match the following -A number used to multiply or divide a quantity when converting from one system of units to another

The notification sent by the insurance carrier to the patient and provider after a claim has been processed is known as a(n):

During the patient's care, all procedures and tests are documented on the:

Match the following -The act of processing a claim that consists of edits, review, and determination.

A claim that is removed from a payer's automated processing system for additional review is subject to:

The patient is responsible for the difference between the provider's usual charge and the carrier's allowed charge when services are received from a participating provider.

If a claim is denied, what process can be followed to request that the carrier reconsider the decision?

Participating providers can demand payment in full from the patient rather than waiting for the insurance carrier to process the claim.

The benefit payment information on an EOB indicates who was paid, how much, and when.

A lockbox service provided by a bank helps control receivables by collecting and depositing carrier and patient payments faster than if the process were performed by office staff.

Under Medicare Part B, reimbursement to a participating provider is based on:

What is the benefit specified in an insurance policy that is different from out-of-pocket expenses because once the stated maximum has been met for a lifetime, no more benefits will be paid?

Before the Omnibus Budget Reconciliation Act (OBRA) of 1989, Medicare payments to providers were based on:

The National uniform conversion factor is updated annually by:

The amount of time it takes for the insurance carrier to process a claim is called the ________ time.

Match the following -The amount that a policyholder must pay for covered services before insurance benefits begin to pay

In regard to the RBRVS system, the technical skill of the provider is considered to be part of the:

State and federal regulations determine how long patient records must be kept and stored.

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

The steps that result in an insurance carrier's decision to either pay or deny a claim are known as:

Claims processing involves the verification of medical necessity for the reported procedures; this task is performed by:

Match the following -A number used to multiply or divide a quantity when converting from one system of units to another

The notification sent by the insurance carrier to the patient and provider after a claim has been processed is known as a(n):

During the patient's care, all procedures and tests are documented on the:

Match the following -The act of processing a claim that consists of edits, review, and determination.

A claim that is removed from a payer's automated processing system for additional review is subject to:

The patient is responsible for the difference between the provider's usual charge and the carrier's allowed charge when services are received from a participating provider.

If a claim is denied, what process can be followed to request that the carrier reconsider the decision?

Participating providers can demand payment in full from the patient rather than waiting for the insurance carrier to process the claim.

The benefit payment information on an EOB indicates who was paid, how much, and when.

A lockbox service provided by a bank helps control receivables by collecting and depositing carrier and patient payments faster than if the process were performed by office staff.

Under Medicare Part B, reimbursement to a participating provider is based on:

What is the benefit specified in an insurance policy that is different from out-of-pocket expenses because once the stated maximum has been met for a lifetime, no more benefits will be paid?

Before the Omnibus Budget Reconciliation Act (OBRA) of 1989, Medicare payments to providers were based on:

The National uniform conversion factor is updated annually by:

The amount of time it takes for the insurance carrier to process a claim is called the ________ time.

Match the following -The amount that a policyholder must pay for covered services before insurance benefits begin to pay

In regard to the RBRVS system, the technical skill of the provider is considered to be part of the:

State and federal regulations determine how long patient records must be kept and stored.

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