Deck 6: Creating Claims

Question 1

This amount is usually due from the insured before benefits begin.

A) copay
B) coinsurance
C) deductible
D) capitation

Answer 1

deductible

Question 2

Medical insurance represents an agreement between the ________________________ and a health plan.

A) payer
B) policyholder
C) physician
D) nurse

Answer 2

policyholder

Question 3

Payments made to the health plan by the policyholder for insurance coverage are called

A) copayments.
B) coinsurance.
C) premiums.
D) deductible.

Answer 3

premiums.

Question 4

Which of the following is a type of health insurance in which organizations control both the financing and the delivery of healthcare to policyholders?

A) medicare
B) managed care
C) preferred provider organization
D) high-deductible health plans

Question 5

What happens to a claim if it contains an error?

A) It may be denied.
B) It may be delayed.
C) It may be rejected.
D) All of these are correct.

Question 6

What information do claims communicate to a payer about a patient?

A) diagnosis
B) charges
C) procedures
D) All of these are correct.

Question 7

Which of the following would be considered a clean claim?

A) a claim that has the correct information for the patient and the encounter
B) a claim that has the patient's information correct but a wrong diagnosis code
C) a claim that has some incorrect patient information but accurate information about the encounter
D) All of these are correct.

Question 8

Claims that are not paid in full can have a negative effect on ___________.

A) the quality of healthcare provided
B) the practice's bottom line
C) the quality of healthcare provided and the practice's bottom line
D) the patient's bottom line

Question 9

How are almost all claims sent today?

A) via the mail
B) via the patient
C) electronically
D) on paper

Question 10

Which of the following insurance claims can be prepared in the practice management program?

A) CMS-1500
B) HIPAA Equivalent Encounter Information (837P)
C) HIPAA X12 837 Health Care Claim
D) All of these are correct.

Question 11

How many data elements are represented by the CMS-1500?

A) 33
B) 150
C) 244
D) 1,054

Question 12

About how many data elements are represented by the 837P?

A) 33
B) 150
C) 244
D) 1,054

Question 13

Which of the following claim forms allows for more data to be included?

A) CMS-1500
B) paper claim
C) 837P
D) CMS-1500 and paper claim

Question 14

What is the next step once the services a patient has received from a provider have been entered into the practice management program?

A) creating insurance claims
B) treating the patient
C) contacting the patient's insurance carrier
D) sending an electronic insurance claim

Question 15

Which of the following is a result that can happen with rejected claims?

A) They may cost the practice twice as much as clean claims.
B) They can result in reduced cash flow.
C) They may cost the practice twice as much as clean claims and can result in reduced cash flow.
D) None of these is correct.

Question 16

Which buttons simplify the task of moving from one entry to another in Claim Management?

A) Transition buttons
B) Navigator buttons
C) User buttons
D) Direction buttons

Question 17

Insurance claims may be ____________ within the Claim Management area of Medisoft.

A) edited
B) submitted for payment
C) created
D) All of these are correct.

Question 18

How many navigator buttons are contained in the upper-right corner of the Claim Management dialog box?

A) two
B) three
C) five
D) seven

Question 19

Which button in the Claim Management dialog box reactivates the claim that was most recently active?

A) First Claim button
B) Previous Claim button
C) Next Claim button
D) Last Claim button

Question 20

Which button in the Claim Management dialog box makes the last claim in the list active?

A) First Claim button
B) Previous Claim button
C) Next Claim button
D) Last Claim button

Question 21

Which button in the Claim Management dialog box makes the next claim in the list active?

A) First Claim button
B) Previous Claim button
C) Next Claim button
D) Last Claim button

Question 22

Which button in the Claim Management dialog box reprints a claim that has already been printed?

A) Reprint Claim
B) Print/Send
C) Create Claims
D) None of these

Question 23

What menu in Medisoft is used to access the Claim Management dialog box?

A) the Edit menu
B) the File menu
C) the Activities menu
D) the Reports menu

Question 24

Which of the following statements describes the advantage of navigator buttons?

A) They allow the user to locate cases more quickly.
B) They simplify the task of moving from one entry to another.
C) They simplify the task of submitting claims to an insurance carrier.
D) All of these are correct.

Question 25

Which button in the Claim Management dialog box is used to restore data when necessary?

A) Refresh Data button
B) Restore Data button
C) Next Claim button
D) Last Claim button

Question 26

Which of the following source claims are created in Medisoft?

A) from insurance carrier information in medisoft
B) from transactions previously entered in medisoft
C) from paper claims filed in the office
D) None of these are correct.

Question 27

What can be done with claims after they are created in Medisoft?

A) They can be printed and mailed.
B) They can be transmitted electronically.
C) They can be printed and mailed or transmitted electronically.
D) They can be sent to the patient.

Question 28

How is the Claim Management dialog box displayed in Medisoft?

A) by clicking Claim Management on the Activities menu
B) by clicking the Claim Management shortcut button on the toolbar
C) by clicking Claim Management on the Lists menu
D) by clicking Claim Management on the Activities menu or by clicking the Claim Management shortcut button on the toolbar; both options would work

Question 29

You have made a mistake entering claim information in the Claim Management dialog box and want to redo your work from scratch. Which action would you take?

A) click the Delete button to delete the selected claim and release the transactions bound to the claim
B) click the Close button to close the dialog box
C) click the Edit button, clear out each of the fields, and then begin again
D) None of these are correct.

Question 30

Which of the following claims is made active when the Next Claim button is clicked in the Claim Management dialog box?

A) the first claim entered in Medisoft
B) the next claim in the list
C) the next claim is displayed at random.
D) the next claim for a given patient

Question 31

Which of these actions may be performed in the Claim Management dialog box?

A) The status of existing claims can be changed.
B) Claims can be printed or submitted electronically.
C) Existing claims can be reviewed and edited.
D) All of these are correct.

Question 32

Which button in the Claim Management dialog box begins the process of sending electronic claims or printing paper claims?

A) Reprint Claim
B) Print/Send
C) Create Claims
D) Edit

Question 33

You have been asked to make some changes to a claim before it is sent to an insurance carrier. How would you accomplish this task in the Claim Management dialog box?

A) click the Edit button to open the claim and correct the data
B) click the Create Claims button to resubmit the correct data
C) click the Delete button to erase the claim and start over
D) None of these are correct.

Question 34

In what dialog box are claims created in Medisoft?

A) Transaction Entry
B) Create Claims
C) Claim Management
D) Edit Claims

Question 35

In Medisoft, what is a condition that data must meet to be selected?

A) filter
B) qualifier
C) classifier
D) sorter

Question 36

What type of claims can be created using filters in Medisoft?

A) claims for specific patients
B) claim transactions that exceed a certain dollar amount
C) claims for specific insurance carriers
D) All of these are correct.

Question 37

What button is clicked to create the claims once all necessary information has been entered in the Create Claims dialog box?

A) Display
B) Process
C) Create
D) Cancel

Question 38

More than one insurance carrier code can be entered in the Primary Insurance box if claims are being sent to a _______________.

A) clearinghouse
B) attending provider
C) assigned provider
D) carrier

Question 39

You are working at a practice and have been asked to create claims for services performed between the 15th of the month and the end of the month. What feature of Medisoft may be used to accomplish this task?

A) apply an edit to the data in Medisoft
B) apply a filter to the data in Medisoft
C) apply a condition to the data in Medisoft
D) None of these are correct.

Question 40

Which type of the following data can be used in a filter?

A) transaction dates
B) billing codes
C) chart numbers
D) All of these are correct.

Question 41

What must be placed in between insurance carrier codes in the Primary Insurance field of the Create Claims dialog box?

A) hyphens
B) periods
C) commas
D) brackets

Question 42

What chart numbers will be included if the Chart Numbers boxes are left blank in the Create Claims dialog box?

A) all chart numbers
B) no chart numbers
C) the chart numbers from the previous search
D) None of these are correct; the fields must be completed.

Question 43

How many insurance carrier codes may be entered in the Primary Insurance box if claims are being sent to a clearinghouse?

A) zero
B) one
C) more than one
D) None of these is correct; these types of claims are not sent to clearinghouses.

Question 44

How does the dollar amount entered in the Enter Amount box of the Create Claims dialog box filter data?

A) It acts as the maximum total amount required for a case before a claim can be created.
B) It acts as the minimum total amount required for a case before a claim can be created.
C) It acts as the maximum amount required for each procedure in a case before a claim can be created.
D) It acts as the minimum amount required for each procedure in a case before a claim can be created.

Question 45

What radio button(s) may be selected in the Provider box of the Create Claims dialog box?

A) assigned
B) attending
C) referring
D) assigned and attending

Question 46

Who does the Assigned radio button in the Provider box indicate?

A) the patient's regular physician
B) the physician the patient was scheduled to see
C) the physician who referred the patient
D) the physician who received the patient via a referral

Question 47

You have been asked to create claims for all the procedures that were performed at a specific hospital. What filter would you use from the Create Claims dialog box to accomplish this task?

A) billing codes
B) case indicator
C) location
D) transaction Dates

Question 48

You have been asked to create claims for all the cases that have charges totaling at least $500. What filter would you use from the Create Claims dialog box to accomplish this task?

A) Billing Codes
B) Enter Amount
C) Case Indicator
D) Primary Insurance

Question 49

You have been asked to create claims for all the cases for patients who are covered by Blue Cross Blue Shield. What filter would you use from the Create Claims dialog box to accomplish this task?

A) Billing Codes
B) Enter Amount
C) Case Indicator
D) Primary Insurance

Question 50

What do the filters in the List Only Claims That Match dialog box do with the existing claims that meet the specified criteria?

A) create them
B) list them
C) highlight them
D) delete them

Question 51

By what characteristic may claims in the List Only Claims That Match dialog box be sorted?

A) insurance carrier
B) billing method
C) claim status
D) All of these are correct.

Question 52

By what characteristic can claims in the List Only Claims That Match not be sorted?

A) electronic claim (EDI) receiver
B) batch number
C) procedure code
D) chart number

Question 53

Claims that are prepared for submission to an insurance carrier must be reviewed for ____________ after they are selected.

A) completeness
B) accuracy
C) completeness and accuracy
D) None of these are correct.

Question 54

If a claim is rejected by an insurance carrier, it should be ____________ before resubmission.

A) reviewed
B) deleted
C) filtered
D) All of these are correct.

Question 55

What boxes need to be filled in the List Only Claims That Match dialog box to select the desired claims?

A) All the boxes need to be filled.
B) Only the boxes that will be used to select the desired claims need to be filled in.
C) The Chart Number and Claim Created boxes must be filled in.
D) The Claim Status must be selected.

Question 56

Which method is used to restore the List Only Claims That Match dialog box to its original settings once it has been reopened?

A) click the Defaults button, then click the Apply button
B) click the Apply button, then the Defaults button
C) click the Cancel button, then the Defaults button
D) click the Cancel button, then the Apply button

Question 57

What box in the List Only Claims That Match dialog box is clicked to exclude claims that have been billed and accepted from a search?

A) Hold
B) Challenge
C) Alert
D) Exclude Done

Question 58

What choice(s) is/are available in the Select Claims for Only section of the List Only Claims That Match dialog box?

A) all
B) secondary
C) tertiary
D) All of these are correct.

Question 59

How are the selected filters applied to the claims data once the desired boxes have been filled in on the List Only Claims That Match dialog box?

A) The filters are applied automatically.
B) click the Apply button.
C) click the Defaults button.
D) None of these are correct.

Question 60

What radio button choice exists in the Billing Method box of the List Only Claims That Match dialog box?

A) Paper
B) Electronic
C) All
D) All of these are correct.

Question 61

What dialog box is displayed after the desired boxes in the List Only Claims That Match dialog box have been filled in and the Apply button is clicked?

A) The List Only Claims That Match dialog box reappears with the new information.
B) Create Claims dialog box
C) Claim Management dialog box
D) None of these are correct.

Question 62

What happens to the List Only Claims That Match dialog box when it is restored to its original settings using the Apply button?

A) All the boxes in the dialog box will become blank.
B) The full list of claims is again displayed in the Claim Management dialog box.
C) All the boxes in the dialog box will become blank and the full list of claims is again displayed in the Claim Management dialog box.
D) None of these are correct.

Question 63

Which of the boxes in the List Only Claims That Match dialog box utilizes the MMDDCCYY format?

A) Claim Created
B) Chart Number
C) Batch Number
D) EDI Receiver

Question 64

Which of the tabs in the Claim dialog box displays information about claims being submitted to a patient's primary insurance carrier?

A) Carrier 1 tab
B) Transactions tab
C) Comment tab
D) Carrier 2 and Carrier 3 tabs

Question 65

Which of the tabs in the Claim dialog box lists information about the transactions included in a claim?

A) Carrier 1 tab
B) Transactions tab
C) Comment tab
D) Carrier 2 and Carrier 3 tabs

Question 66

Which of the tabs in the Claim dialog box display information about claims being submitted to a patient's secondary and tertiary insurance carriers?

A) Carrier 1 tab
B) Transactions tab
C) Comment tab
D) Carrier 2 and Carrier 3 tabs

Question 67

Which of the tabs in the Claim dialog box provides a place to include specific notes or comments about the claim?

A) Carrier 1 tab
B) Transactions tab
C) Comment tab
D) Carrier 2 and Carrier 3 tabs

Question 68

Which of the following entries are allowed in the Frequency Type field of the Carrier 1 tab?

A) replacement entries
B) original entries
C) void entries
D) All of these are correct.

Question 69

What is the purpose of the comments in the Comment tab of the Claim dialog box?

A) for electronic transmission
B) for internal use only
C) for printing on statements
D) All of these are correct.

Question 70

How can a claim that is active in the Claim Management dialog box be edited?

A) by clicking the Edit button
B) by double-clicking the claim itself
C) by right-clicking the claim itself
D) by clicking the Edit button or by double-clicking the claim itself-both options would work

Question 71

Which of the following information in the Claim dialog box may not be edited?

A) the information in the top section
B) the information in the Carrier 1 tab
C) the information in the Transactions tab
D) the information in the Comment tab

Question 72

What are the differences between the Carrier 1 tab and the Carrier 2 and Carrier 3 tabs?

A) The Carrier 2 and Carrier 3 tabs do not have a Frequency Type box.
B) The Carrier 1 tab has a Pending radio button in the Claim Status box.
C) The Carrier 2 and Carrier 3 tabs do not have a Frequency Type box, and the Carrier 1 tab has a Pending radio button in the Claim Status box.
D) There are no differences.

Question 73

Which of the following is a button at the bottom of the Transactions tab?

A) Split
B) Add
C) Remove
D) All of these are correct.

Question 74

How would you indicate that a secondary insurance carrier is responsible for a claim in the Transactions tab of the Claim dialog box?

A) check the Ins 1 Resp box.
B) check the Ins 2 Resp box.
C) check the Ins 3 Resp box.
D) check the Amount box.

Question 75

What is entered in the Amount box in the Transactions tab of the Claim dialog box?

A) the dollar cost of a service
B) the amount of a patient's payment
C) the amount of an insurance carrier's payment
D) the dollar cost of the copayment

Question 76

What does the Submission Count area of the Carrier 1 tab list?

A) the number of procedures performed
B) the number of claims submitted
C) the number of diagnoses provided
D) the batch number

Question 77

You are filing an insurance claim electronically through Medisoft and need to indicate that the claim you are sending is a replacement of a previously sent claim. How would you indicate this in Medisoft?

A) enter 7 in the Frequency Type field of the Carrier 1 tab
B) enter 8 in the Frequency Type field of the Carrier 1 tab
C) enter 7 in the Frequency Type field of the Carrier 2 tab
D) enter 8 in the Frequency Type field of the Carrier 2 tab

Question 78

You are filing an insurance claim electronically through Medisoft and need to indicate that the claim you are sending is an adjustment of a claim. How would you indicate this in Medisoft?

A) enter 1 in the Frequency Type field of the Carrier 1 tab
B) enter 6 in the Frequency Type field of the Carrier 1 tab
C) enter 1 in the Frequency Type field of the Carrier 2 tab
D) enter 6 in the Frequency Type field of the Carrier 2 tab

Question 79

What information is displayed in the Batch field in the Carrier 1 tab?

A) the number of claims in a batch
B) the number of batches that have been sent
C) the batch number
D) None of these are correct.

Question 80

In Medisoft, how can a user remove a single transaction from an existing claim and place it on a new claim?

A) the Add button in the Transactions tab of the Case dialog box
B) the Remove button in the Transactions tab of the Case dialog box
C) the Amount button in the Transactions tab of the Case dialog box
D) the Split button in the Transactions tab of the Case dialog box