Question 1

The health insurance professional should be familiar with the CMS-1500 paper claim process because:

Accepted Answer

A)  the NUCC recommends it. 
B)  it is a HIPAA mandate. 
C)  not all providers submit claims electronically. 
D)  the CMS-1500 form must be used for Medicare claims. 
A)  the NUCC recommends it. 
B)  it is a HIPAA mandate. 
C)  not all providers submit claims electronically. 
D)  the CMS-1500 form must be used for Medicare claims. C

Question 2

When it becomes necessary to include attachments with a paper claim,what provider information should appear on each document?

Accepted Answer

Attachments should include the practice name,provider/group number,address,and telephone number.

Question 3

Why should the health insurance professional photocopy both sides of a patient's health insurance identification card?

Accepted Answer

Frequently,the back of the insurance ID card contains pertinent information such as the address where to send the claim,telephone numbers for acquiring precertification,and/or customer service assistance for claims questions.

Question 4

If a patient and his or her spouse are covered under two separate employer group policies,it results in a coordination of benefits.

Accepted Answer

A) True 
 B)False

Question 5

An explanation of benefits is often referred to as a/an:

Accepted Answer

A)  general ledger file. 
B)  remittance advice. 
C)  tracking file. 
D)  insurance claims register. 
A)  general ledger file. 
B)  remittance advice. 
C)  tracking file. 
D)  insurance claims register.

Question 6

When a claims error that could result in inaccurate reimbursement is discovered,a corrected claim should be prepared and submitted according to the payer's guidelines.

Accepted Answer

A) True 
 B)False

Question 7

Before appealing a claim,the health insurance professional should notify the insurer in writing that there has been an error.

Accepted Answer

A) True 
 B)False

Question 8

When initiating an appeal,in order that the appropriate steps are followed,the health insurance professional should consult the:

Accepted Answer

A)  patient. 
B)  carrier's guidelines. 
C)  policy of the practice. 
D)  state law. 
A)  patient. 
B)  carrier's guidelines. 
C)  policy of the practice. 
D)  state law.

Question 9

If the health insurance professional believes a claim has been wrongly denied,he or she can:

Accepted Answer

A)  file an appeal. 
B)  start a small claims lawsuit. 
C)  disregard the denied claim and resubmit it. 
D)  do nothing; once a claim is denied, it is finished. 
A)  file an appeal. 
B)  start a small claims lawsuit. 
C)  disregard the denied claim and resubmit it. 
D)  do nothing; once a claim is denied, it is finished.

Question 10

A suspension file is a series of files customarily set up:

Accepted Answer

A)  alphabetically. 
B)  numerically. 
C)  phonetically. 
D)  chronologically. 
A)  alphabetically. 
B)  numerically. 
C)  phonetically. 
D)  chronologically.

Question 11

Before the health insurance professional completes and submits health insurance claims,a __________ is typically on file.

Accepted Answer

A)  signed and dated release of information 
B)  completed explanation of benefits form 
C)  coordination of benefits form 
D)  correct code initiative 
A)  signed and dated release of information 
B)  completed explanation of benefits form 
C)  coordination of benefits form 
D)  correct code initiative

Question 12

The National Correct Coding Initiative (NCCI)develops correct coding methods for CMS that are intended to reduce overpayments that result from improper coding.

Accepted Answer

A) True 
 B)False

Question 13

Not all medical practices follow the same strategy when it comes to the frequency of submitting insurance claims.What are some of the things that affect this process?

Accepted Answer

The size of the practice
Office staffing

Question 14

An explanation of benefits (EOB)is sometimes called a remittance advice (RA).

Accepted Answer

A) True 
 B)False

Question 15

When a coordination of benefits situation exists,the health insurance professional should first:

Accepted Answer

A)  disregard the primary payer. 
B)  disregard the secondary payer. 
C)  verify which payer is primary and which is secondary. 
D)  submit two claims simultaneously. 
A)  disregard the primary payer. 
B)  disregard the secondary payer. 
C)  verify which payer is primary and which is secondary. 
D)  submit two claims simultaneously.

Question 16

Ideally,patients should be asked to update their information forms at least annually.

Accepted Answer

A) True 
 B)False

Question 17

The EIN is a nine-digit number that serves as a taxpayer's identifying number.

Accepted Answer

A) True 
 B)False

Question 18

A common error that can cause a claim to be rejected is:

Accepted Answer

A)  incorrect patient ID number. 
B)  missing physician's EIN number. 
C)  invalid CPT or ICD codes. 
D)  all of the above 
A)  incorrect patient ID number. 
B)  missing physician's EIN number. 
C)  invalid CPT or ICD codes. 
D)  all of the above

Question 19

Generally,if a claim is reduced or rejected,the problem lies with the:

Accepted Answer

A)  provider's office. 
B)  patient. 
C)  insurance company. 
D)  fiscal intermediary. 
A)  provider's office. 
B)  patient. 
C)  insurance company. 
D)  fiscal intermediary.

Question 20

Established patients should be required to update their information form:

Accepted Answer

A)  daily. 
B)  monthly. 
C)  at least annually. 
D)  none of these; established patients do not need to update their information. 
A)  daily. 
B)  monthly. 
C)  at least annually. 
D)  none of these; established patients do not need to update their information.

The health insurance professional should be familiar with the CMS-1500 paper claim process because:

When it becomes necessary to include attachments with a paper claim,what provider information should appear on each document?

Why should the health insurance professional photocopy both sides of a patient's health insurance identification card?

If a patient and his or her spouse are covered under two separate employer group policies,it results in a coordination of benefits.

An explanation of benefits is often referred to as a/an:

When a claims error that could result in inaccurate reimbursement is discovered,a corrected claim should be prepared and submitted according to the payer's guidelines.

Before appealing a claim,the health insurance professional should notify the insurer in writing that there has been an error.

When initiating an appeal,in order that the appropriate steps are followed,the health insurance professional should consult the:

If the health insurance professional believes a claim has been wrongly denied,he or she can:

A suspension file is a series of files customarily set up:

Before the health insurance professional completes and submits health insurance claims,a __________ is typically on file.

The National Correct Coding Initiative (NCCI)develops correct coding methods for CMS that are intended to reduce overpayments that result from improper coding.

Not all medical practices follow the same strategy when it comes to the frequency of submitting insurance claims.What are some of the things that affect this process?

An explanation of benefits (EOB)is sometimes called a remittance advice (RA).

When a coordination of benefits situation exists,the health insurance professional should first:

Ideally,patients should be asked to update their information forms at least annually.

The EIN is a nine-digit number that serves as a taxpayer's identifying number.

A common error that can cause a claim to be rejected is:

Generally,if a claim is reduced or rejected,the problem lies with the:

Established patients should be required to update their information form:

The Origins of Health Insurance

Tools of the Trade: A Career as a Health (Medical)Insurance Professional

The Legal and Ethical Side of Medical Insurance

Types and Sources of Health Insurance

Claim Submission Methods

Traditional Fee For Service/Private Plans

Unraveling the Mysteries of Managed Care

Understanding Medicaid

Conquering Medicare’s Challenges

Military Carriers

Miscellaneous Carriers: Workers’ Compensation and Disability Insurance

Diagnostic Coding

Procedural, Evaluation and Management, and HCPCS Coding

The Patient

The Role of Computers in Health Insurance

Reimbursement Procedures: Getting Paid

Hospital Billing and the UB-04

Filters

Exam 15: Keys to Successful Claims Management

The health insurance professional should be familiar with the CMS-1500 paper claim process because:

When it becomes necessary to include attachments with a paper claim,what provider information should appear on each document?

Why should the health insurance professional photocopy both sides of a patient's health insurance identification card?

If a patient and his or her spouse are covered under two separate employer group policies,it results in a coordination of benefits.

An explanation of benefits is often referred to as a/an:

When a claims error that could result in inaccurate reimbursement is discovered,a corrected claim should be prepared and submitted according to the payer's guidelines.

Before appealing a claim,the health insurance professional should notify the insurer in writing that there has been an error.

When initiating an appeal,in order that the appropriate steps are followed,the health insurance professional should consult the:

If the health insurance professional believes a claim has been wrongly denied,he or she can:

A suspension file is a series of files customarily set up:

Before the health insurance professional completes and submits health insurance claims,a __________ is typically on file.

The National Correct Coding Initiative (NCCI)develops correct coding methods for CMS that are intended to reduce overpayments that result from improper coding.

Not all medical practices follow the same strategy when it comes to the frequency of submitting insurance claims.What are some of the things that affect this process?

An explanation of benefits (EOB)is sometimes called a remittance advice (RA).

When a coordination of benefits situation exists,the health insurance professional should first:

Ideally,patients should be asked to update their information forms at least annually.

The EIN is a nine-digit number that serves as a taxpayer's identifying number.

A common error that can cause a claim to be rejected is:

Generally,if a claim is reduced or rejected,the problem lies with the:

Established patients should be required to update their information form:

The Origins of Health Insurance

Tools of the Trade: A Career as a Health (Medical)Insurance Professional

The Legal and Ethical Side of Medical Insurance

Types and Sources of Health Insurance

Claim Submission Methods

Traditional Fee For Service/Private Plans

Unraveling the Mysteries of Managed Care

Understanding Medicaid

Conquering Medicare’s Challenges

Military Carriers

Miscellaneous Carriers: Workers’ Compensation and Disability Insurance

Diagnostic Coding

Procedural, Evaluation and Management, and HCPCS Coding

The Patient

The Role of Computers in Health Insurance

Reimbursement Procedures: Getting Paid

Hospital Billing and the UB-04

Filters