Question 1

Which is considered a financial source document from which an insurance claim is generated?

Accepted Answer

A)   CMS-1500 claim
B)   encounter form
C)   ledger card
D)   patient recordE) B) and D)
F) B) and C)

Question 2

Which is the financial record source document used by health care providers and other personnel to record treated diagnoses and services rendered to the patient during the current visit?

Accepted Answer

A)   CMS-1500 claim
B)   encounter form
C)   explanation of benefits
D)   remittance adviceE) C) and D)
F) A) and D)

Question 3

Which claims are organized by year and are generated for providers who do not accept assignment?

Accepted Answer

A)   clean claims
B)   closed claims
C)   open claims
D)   unassigned claimsE) C) and D)
F) A) and B)

Question 4

Which is a computerized permanent record of all financial transactions between the patient and the practice?

Accepted Answer

A)   health record
B)   patient account record
C)   patient ledger
D)   remittance adviceE) A) and D)
F) A) and C)

Question 5

Coordination of benefits (COB)  is a provision in __________ health insurance policies intended to keep multiple insurers from paying benefits covered by other policies.

Accepted Answer

A)   all
B)   commercial
C)   group
D)   privateE) A) and D)
F) B) and D) C

Question 6

Which is the financial record source document used by health care providers and other personnel in a hospital outpatient setting to select codes for treated diagnoses and services rendered to the patient during the current visit?

Accepted Answer

A)   chargemaster
B)   explanation of benefits
C)   remittance advice
D)   superbillE) C) and D)
F) A) and D)

Question 7

A remittance advice submitted to the provider electronically is called an electronic remittance advice (ERA) , and __________.

Accepted Answer

A)   different information is included as compared with a paper-based remittance advice
B)   it contains identical information to the information on a paper-based remittance advice
C)   payers are required to increase the amount of reimbursement paid to the provider
D)   similar information is included in the exact format as a paper-based remittance adviceE) None of the above
F) C) and D)

Question 8

When a child lives with both parents, and each parent subscribes to a different health insurance plan, the primary and secondary policies are determined by applying the birthday rule. The individual who holds the primary policy for dependent children is the spouse whose birth __________.

Accepted Answer

A)   day occurs earlier in the month
B)   month and day occur earlier in the calendar year
C)   month, day, and year occur earlier
D)   year occurs earlierE) A) and D)
F) A) and C)

Question 9

Dr. Smith is a participating provider (PAR)  for the ABC Health Insurance Plan. Mary Talley is treated by Dr. Smith in the office, for which a $100 fee is charged. Given the information in the table located below, calculate the PAR provider write-off amount.

Accepted Answer

A)   $10
B)   $20
C)   $30
D)   $40E) B) and C)
F) A) and B)

Question 10

Which involves sorting claims upon submission to collect and verify information about the patient and provider?

Accepted Answer

A)   claims adjudication
B)   claims payment
C)   claims processing
D)   claims submissionE) B) and C)
F) A) and B)

Question 11

When dealing with delinquent claims, it is important to review records to determine whether the claim was paid, was denied, or is pending. A pending claim is considered in __________.

Accepted Answer

A)   adjudication
B)   denial
C)   receipt
D)   suspenseE) A) and B)
F) A) and C)

Question 12

Which claims are filed according to year and insurance company and include those for which all processing, including appeals, has been completed?

Accepted Answer

A)   clean claims
B)   closed claims
C)   open claims
D)   unassigned claimsE) All of the above
F) C) and D)

Question 13

Health insurance plans may include a(n)  __________ provision, which means that when the patient has reached that limit for the year, appropriate patient reimbursement to the provider is determined.

Accepted Answer

A)   assignment of benefits
B)   coinsurance and copayment
C)   deductible
D)   out-of-pocket paymentE) All of the above
F) A) and D)

Question 14

Which are the amounts owed to a business for services or goods provided?

Accepted Answer

A)   accounts payable
B)   accounts receivable
C)   allowed charges
D)   assignment of benefitsE) None of the above
F) B) and D)

Question 15

Which states that third-party debt collectors are prohibited from employing deceptive or abusive conduct in the collection of consumer debts incurred for personal, family, or household purposes?

Accepted Answer

A)   Fair Credit and Charge Card Disclosure Act
B)   Fair Credit Billing Act
C)   Fair Credit Reporting Act
D)   Fair Debt Collection Practices ActE) C) and D)
F) A) and C)

Question 16

When selecting a clearinghouse, providers may also want to determine whether it is accredited by the __________.

Accepted Answer

A)   Centers for Medicare and Medicaid Services
B)   Electronic Healthcare Network Accreditation Commission
C)   Joint Commission
D)   National Committee for Quality AssuranceE) A) and D)
F) C) and D) B

Question 17

Which is the financial record source document used by health care providers and other personnel in a physician's office setting to record treated diagnoses and services rendered to the patient during the current visit?

Accepted Answer

A)   CMS-1500 claim
B)   explanation of benefits
C)   remittance advice
D)   superbillE) A) and D)
F) None of the above

Question 18

A claims attachment is __________ documentation associated with a health care claim or patient encounter.

Accepted Answer

A)   coding
B)   payment
C)   remittance
D)   supportingE) A) and B)
F) A) and C)

Question 19

The computer-to-computer transfer of data between providers and third-party payers (or providers and health care clearinghouses)  in a data format agreed upon by sending and receiving parties is called electronic __________.

Accepted Answer

A)   data interchange
B)   flat file format
C)   media claim
D)   remittance adviceE) A) and B)
F) A) and C) A

Question 20

Which is an electronic format supported for health care claims transactions?

Accepted Answer

A)   ANSI ASC X12 837
B)   CMS-1500 claim
C)   national drug code format
D)   UB-04 claimE) All of the above
F) B) and C)

Exam 4: Processing an Insurance Claim

Which is considered a financial source document from which an insurance claim is generated?

Correct AnswerverifiedShow Answer

Which is the financial record source document used by health care providers and other personnel to record treated diagnoses and services rendered to the patient during the current visit?

Correct AnswerverifiedShow Answer

Which claims are organized by year and are generated for providers who do not accept assignment?

Correct AnswerverifiedShow Answer

Which is a computerized permanent record of all financial transactions between the patient and the practice?

Correct AnswerverifiedShow Answer

Coordination of benefits (COB) is a provision in __________ health insurance policies intended to keep multiple insurers from paying benefits covered by other policies.

Correct AnswerverifiedC

Which is the financial record source document used by health care providers and other personnel in a hospital outpatient setting to select codes for treated diagnoses and services rendered to the patient during the current visit?

Correct AnswerverifiedShow Answer

A remittance advice submitted to the provider electronically is called an electronic remittance advice (ERA) , and __________.

Correct AnswerverifiedShow Answer

When a child lives with both parents, and each parent subscribes to a different health insurance plan, the primary and secondary policies are determined by applying the birthday rule. The individual who holds the primary policy for dependent children is the spouse whose birth __________.

Correct AnswerverifiedShow Answer

Dr. Smith is a participating provider (PAR) for the ABC Health Insurance Plan. Mary Talley is treated by Dr. Smith in the office, for which a $100 fee is charged. Given the information in the table located below, calculate the PAR provider write-off amount.

Correct AnswerverifiedShow Answer

Which involves sorting claims upon submission to collect and verify information about the patient and provider?

Correct AnswerverifiedShow Answer

When dealing with delinquent claims, it is important to review records to determine whether the claim was paid, was denied, or is pending. A pending claim is considered in __________.

Correct AnswerverifiedShow Answer

Which claims are filed according to year and insurance company and include those for which all processing, including appeals, has been completed?

Correct AnswerverifiedShow Answer

Health insurance plans may include a(n) __________ provision, which means that when the patient has reached that limit for the year, appropriate patient reimbursement to the provider is determined.

Correct AnswerverifiedShow Answer

Which are the amounts owed to a business for services or goods provided?

Correct AnswerverifiedShow Answer

Which states that third-party debt collectors are prohibited from employing deceptive or abusive conduct in the collection of consumer debts incurred for personal, family, or household purposes?

Correct AnswerverifiedShow Answer

When selecting a clearinghouse, providers may also want to determine whether it is accredited by the __________.

Correct AnswerverifiedB

Which is the financial record source document used by health care providers and other personnel in a physician's office setting to record treated diagnoses and services rendered to the patient during the current visit?

Correct AnswerverifiedShow Answer

A claims attachment is __________ documentation associated with a health care claim or patient encounter.

Correct AnswerverifiedShow Answer

The computer-to-computer transfer of data between providers and third-party payers (or providers and health care clearinghouses) in a data format agreed upon by sending and receiving parties is called electronic __________.

Correct AnswerverifiedA

Which is an electronic format supported for health care claims transactions?

Correct AnswerverifiedShow Answer

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C

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B

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A

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