Question 1

A(n) _____ ensures that the patient will pay for services received if a referral is not documented in the time specified.

Accepted Answer

A)  referral waiver 
B)  guarantee waiver 
C)  documentation waiver 
D)  endorsement waiver 
A)  referral waiver 
B)  guarantee waiver 
C)  documentation waiver 
D)  endorsement waiver

Question 2

When determining a patient's primary insurance and the patient has two group policies, which one is the primary?

Accepted Answer

A)  the plan that has been in effect the longest period of time 
B)  the plan that has the lower co pay 
C)  the plan that has the highest premium 
D)  the plan that has lowest deductible 
A)  the plan that has been in effect the longest period of time 
B)  the plan that has the lower co pay 
C)  the plan that has the highest premium 
D)  the plan that has lowest deductible

Question 3

When prior authorization is approved, where does the medical assistant enter the prior authorization number for use later on a health care claim?

Accepted Answer

A)  PMP 
B)  HSS 
C)  CPT form 
D)  ICD form 
A)  PMP 
B)  HSS 
C)  CPT form 
D)  ICD form

Question 4

A (n) _____ is patient who has been seen a provider within the past three years.

Accepted Answer

A)  dependent 
B)  established patient 
C)  new patient 
D)  independent 
A)  dependent 
B)  established patient 
C)  new patient 
D)  independent

Question 5

In the practice management program (PMP) a unique number that identifies a patient is called ___.

Accepted Answer

A)  identification number 
B)  social security number 
C)  chart number 
D)  patient number 
A)  identification number 
B)  social security number 
C)  chart number 
D)  patient number

Question 6

A ____ is the physician who refers a patient to another physician.

Accepted Answer

A)  specialist 
B)  secondary physician 
C)  referring physician 
D)  recommended physician 
A)  specialist 
B)  secondary physician 
C)  referring physician 
D)  recommended physician

Question 7

Which of the following is not a step to establishing financial responsibility for an established patient?

Accepted Answer

A)  Verify patients' eligibility for insurance benefits. 
B)  Determine preauthorization and referral requirements. 
C)  Determine the primary payer if more than one insurance plan is in effect 
D)  Determine if the patient has been out of the country in the past 90 days 
A)  Verify patients' eligibility for insurance benefits. 
B)  Determine preauthorization and referral requirements. 
C)  Determine the primary payer if more than one insurance plan is in effect 
D)  Determine if the patient has been out of the country in the past 90 days

Question 8

When determining a patient's primary insurance and the patient has coverage under both a group and an individual plan, which one is the primary insurance?

Accepted Answer

A)  individual plan 
B)  group plan 
C)  the plan that has the lower co pay 
D)  the plan the patient chooses 
A)  individual plan 
B)  group plan 
C)  the plan that has the lower co pay 
D)  the plan the patient chooses

Question 9

When an established patient shows up for his or her appointment, what is the most important question the front desk staff member should ask?

Accepted Answer

A)  if any pertinent personal or insurance information has changed 
B)  if the patient would like to schedule a follow up visit 
C)  where would the patient wants the results sent 
D)  where would the patient want the referral sent 
A)  if any pertinent personal or insurance information has changed 
B)  if the patient would like to schedule a follow up visit 
C)  where would the patient wants the results sent 
D)  where would the patient want the referral sent

Question 10

Which health plan pays benefits first?

Accepted Answer

A)  primary insurance 
B)  principal plans 
C)  secondary plan 
D)  chief plan 
A)  primary insurance 
B)  principal plans 
C)  secondary plan 
D)  chief plan

Question 11

A(n) ____ is a provider who does not join a particular health plan.

Accepted Answer

A)  nonparticipating provider 
B)  uninsured provider 
C)  participating provider 
D)  non partaking provider 
A)  nonparticipating provider 
B)  uninsured provider 
C)  participating provider 
D)  non partaking provider

Question 12

A coordination of benefits rule that is used to determine which plan is primary when a child has primary insurance under both parents plans is called ____.

Accepted Answer

A)  gender rule 
B)  the parents decide 
C)  the plan that has the lower copay 
D)  the plan that has the lowest deductible 
A)  gender rule 
B)  the parents decide 
C)  the plan that has the lower copay 
D)  the plan that has the lowest deductible

Question 13

What is recorded on the encounter form?

Accepted Answer

A)  insurance contact information 
B)  physician information code 
C)  patients work information 
D)  diagnosis and procedures codes 
A)  insurance contact information 
B)  physician information code 
C)  patients work information 
D)  diagnosis and procedures codes

Question 14

Payers want the name of the patient on a claim _____.

Accepted Answer

A)  to skip middle initials 
B)  to include nicknames 
C)  to be the same as on the patients social security card 
D)  to be exactly as it is shown on the insurance card 
A)  to skip middle initials 
B)  to include nicknames 
C)  to be the same as on the patients social security card 
D)  to be exactly as it is shown on the insurance card

Question 15

When the physician or medical assistant reviews information with the patient during the visit, where is this documented?

Accepted Answer

A)  the process form 
B)  the insurance form 
C)  the practice form 
D)  the medical record 
A)  the process form 
B)  the insurance form 
C)  the practice form 
D)  the medical record

Question 16

If a dependent child's primary insurance does not provide for the complete reimbursement of a bill, who is responsible to pay the balance?

Accepted Answer

A)  the balance is submitted to Medicare 
B)  the balance is submitted to Medicaid 
C)  the balance is submitted to a financial company by the parents 
D)  the balance is submitted to the other parent's plan 
A)  the balance is submitted to Medicare 
B)  the balance is submitted to Medicaid 
C)  the balance is submitted to a financial company by the parents 
D)  the balance is submitted to the other parent's plan

Question 17

HIPAA X12N 270/271 is ____.

Accepted Answer

A)  HIPAA Eligibility for Service Form 
B)  HIPAA Eligibility for a Health Plan electronic transaction form 
C)  HIPAA Eligibility for Health Care at Hospital form 
D)  HIPAA Eligibility For Health Care Out-of State Form 
A)  HIPAA Eligibility for Service Form 
B)  HIPAA Eligibility for a Health Plan electronic transaction form 
C)  HIPAA Eligibility for Health Care at Hospital form 
D)  HIPAA Eligibility For Health Care Out-of State Form

Question 18

Who completes the encounter form?

Accepted Answer

A)  the patient 
B)  the insurance company 
C)  the provider 
D)  the front office staff 
A)  the patient 
B)  the insurance company 
C)  the provider 
D)  the front office staff

Question 19

_____ guidelines that ensure that when a patient has more than one policy, maximum appropriate benefits are paid, but without duplication.

Accepted Answer

A)  coordination of benefits 
B)  reimbursement of benefits 
C)  compensation of benefits 
D)  settlement of benefits 
A)  coordination of benefits 
B)  reimbursement of benefits 
C)  compensation of benefits 
D)  settlement of benefits

Question 20

PIF is the abbreviation for _____.

Accepted Answer

A)  prescription information form 
B)  patient information form 
C)  physician information form 
D)  pharmacy information form 
A)  prescription information form 
B)  patient information form 
C)  physician information form 
D)  pharmacy information form

A(n) _____ ensures that the patient will pay for services received if a referral is not documented in the time specified.

When determining a patient's primary insurance and the patient has two group policies, which one is the primary?

When prior authorization is approved, where does the medical assistant enter the prior authorization number for use later on a health care claim?

A (n) _____ is patient who has been seen a provider within the past three years.

In the practice management program (PMP) a unique number that identifies a patient is called ___.

A ____ is the physician who refers a patient to another physician.

Which of the following is not a step to establishing financial responsibility for an established patient?

When determining a patient's primary insurance and the patient has coverage under both a group and an individual plan, which one is the primary insurance?

When an established patient shows up for his or her appointment, what is the most important question the front desk staff member should ask?

Which health plan pays benefits first?

A(n) ____ is a provider who does not join a particular health plan.

A coordination of benefits rule that is used to determine which plan is primary when a child has primary insurance under both parents plans is called ____.

What is recorded on the encounter form?

Payers want the name of the patient on a claim _____.

When the physician or medical assistant reviews information with the patient during the visit, where is this documented?

If a dependent child's primary insurance does not provide for the complete reimbursement of a bill, who is responsible to pay the balance?

HIPAA X12N 270/271 is ____.

Who completes the encounter form?

_____ guidelines that ensure that when a patient has more than one policy, maximum appropriate benefits are paid, but without duplication.

PIF is the abbreviation for _____.

From Patient to Payment Understanding Medical Insurance

Electronic Health Records, HIPAA, and Hitech: Sharing and Protectin

Diagnostic Coding

Procedural Coding

Payment Methods and Checkout Procedures

Health Care Claim Preparation and Transmission

Private Payersblue Cross and Blue Shield

Medicare

Medicaid

Tricare and Champva

Workers Compensation and Automobiledisability Insurance

Claim Processing, Payments, and Collections

Hospital Insurance

Filters

Exam 3: Patient Encounters and Billing Information

A(n) _____ ensures that the patient will pay for services received if a referral is not documented in the time specified.

When determining a patient's primary insurance and the patient has two group policies, which one is the primary?

When prior authorization is approved, where does the medical assistant enter the prior authorization number for use later on a health care claim?

A (n) _____ is patient who has been seen a provider within the past three years.

In the practice management program (PMP) a unique number that identifies a patient is called ___.

A ____ is the physician who refers a patient to another physician.

Which of the following is not a step to establishing financial responsibility for an established patient?

When determining a patient's primary insurance and the patient has coverage under both a group and an individual plan, which one is the primary insurance?

When an established patient shows up for his or her appointment, what is the most important question the front desk staff member should ask?

Which health plan pays benefits first?

A(n) ____ is a provider who does not join a particular health plan.

A coordination of benefits rule that is used to determine which plan is primary when a child has primary insurance under both parents plans is called ____.

What is recorded on the encounter form?

Payers want the name of the patient on a claim _____.

When the physician or medical assistant reviews information with the patient during the visit, where is this documented?

If a dependent child's primary insurance does not provide for the complete reimbursement of a bill, who is responsible to pay the balance?

HIPAA X12N 270/271 is ____.

Who completes the encounter form?

_____ guidelines that ensure that when a patient has more than one policy, maximum appropriate benefits are paid, but without duplication.

PIF is the abbreviation for _____.

From Patient to Payment Understanding Medical Insurance

Electronic Health Records, HIPAA, and Hitech: Sharing and Protectin

Diagnostic Coding

Procedural Coding

Payment Methods and Checkout Procedures

Health Care Claim Preparation and Transmission

Private Payersblue Cross and Blue Shield

Medicare

Medicaid

Tricare and Champva

Workers Compensation and Automobiledisability Insurance

Claim Processing, Payments, and Collections

Hospital Insurance

Filters