Question 1

A(n)  __________ claim has been completed accurately and completely.

Accepted Answer

A)   clean
B)   dirty
C)   dingy
D)   incompleteE) None of the above
F) C) and D)

Question 2

Services and/or supplies used to treat the patient's diagnosis meet the accepted standard of medical practice is the definition of

Accepted Answer

A)   eligibility.
B)   precertification.
C)   medical necessity.
D)   capitation.E) None of the above
F) A) and B)

Question 3

Dirty claims cannot be resubmitted.

Accepted Answer

A) True 
 B)False

Question 4

Electronic claims are submitted via the internet.

Accepted Answer

A) True 
 B)False

Question 5

A secondary health plan is noted in which block?

Accepted Answer

A)   11a
B)   11b
C)   11c
D)   11dE) None of the above
F) A) and B)

Question 6

The process of determining if a procedure or service is covered by the insurance plan and what the reimbursement is for that procedure is the definition of

Accepted Answer

A)   eligibility.
B)   precertification.
C)   medical necessity.
D)   capitation.E) A) and D)
F) None of the above

Question 7

Patients sign an __________ of benefits form so that the physician will receive payment for services directly.

Accepted Answer

A)   precertification
B)   eligibility
C)   assignment
D)   adjudicationE) None of the above
F) B) and C)

Question 8

The date in block 14 is the date

Accepted Answer

A)   of the filing of the claim.
B)   of the onset of the illness.
C)   the patient signed the claim.
D)   the provider signed the claim.E) B) and D)
F) All of the above

Question 9

Claims submitted to a(n)  __________ are forwarded to individual insurance carriers.

Accepted Answer

A)   scrubber
B)   direct biller
C)   clearinghouse
D)   None of the aboveE) A) and D)
F) A) and C)

Question 10

Procedures performed on the patient are found in what block?

Accepted Answer

A)   24a
B)   24b
C)   24d
D)   24eE) C) and D)
F) None of the above

Question 11

The assignment of benefits is located in block

Accepted Answer

A)   12.
B)   13.
C)   27.
D)   33.E) B) and C)
F) All of the above

Question 12

The billing provider's NPI number is placed in block

Accepted Answer

A)   31.
B)   32.
C)   33a.
D)   33b.E) All of the above
F) B) and D)

Question 13

To settle or determine judicially is the definition of

Accepted Answer

A)   copayment.
B)   deductible.
C)   co-insurance.
D)   adjudicate.E) B) and C)
F) C) and D)

Question 14

Claims that have errors or omissions that must be corrected and resubmitted to receive reimbursement are called _____________ claims.

Accepted Answer

A)   clean
B)   dirty
C)   dingy
D)   incompleteE) A) and B)
F) A) and C)

Question 15

Which of the following is a fixed amount per visit and is typically paid at the time of medical services?

Accepted Answer

A)   Copayment
B)   Deductible
C)   Co-insurance
D)   Both A and BE) A) and B)
F) A) and C)

Question 16

A PAR provider can bill the patient for the difference between their fee and insurance companies allowed amount.

Accepted Answer

A) True 
 B)False

Question 17

Which of the following is a common reason why insurance claims are rejected?

Accepted Answer

A)   When a procedure listed is not an insurance benefit
B)   Lack of insurance coverage on date of service
C)   Not obtaining preauthorization for the service
D)   Claim was sent to the wrong insurance planE) B) and C)
F) C) and D)

Question 18

After the deductible has been met the policyholder is responsible for a certain percentage of the bill is the definition of

Accepted Answer

A)   copayment.
B)   deductible.
C)   co-insurance.
D)   adjudicate.E) None of the above
F) B) and C)

Question 19

Electronic data interchange is

Accepted Answer

A)   transferring data back and forth between two or more entities.
B)   sending information to one insurance carrier.
C)   sending information to one clearinghouse for processing.
D)   None of the aboveE) C) and D)
F) B) and C)

Question 20

Which of the following steps to medical billing should be performed prior to rendering medical services?

Accepted Answer

A)   Verify the patient's eligibility for insurance coverage.
B)   Collect patient insurance information.
C)   Code the diagnosis and procedures.
D)   Complete the CMS-1500 health insurance claim form.
E)   Both A and BF) C) and D)
G) B) and E)

Exam 26: Billing and Reimbursement

After the deductible has been met the policyholder is responsible for a certain percentage of the bill is the definition of

Correct AnswerverifiedShow Answer

Which of the following is a fixed amount per visit and is typically paid at the time of medical services?

Correct AnswerverifiedShow Answer

Dirty claims cannot be resubmitted.

Correct AnswerverifiedShow Answer

A(n) __________ claim has been completed accurately and completely.

Correct AnswerverifiedShow Answer

Claims submitted to a(n) __________ are forwarded to individual insurance carriers.

Correct AnswerverifiedShow Answer

Services and/or supplies used to treat the patient's diagnosis meet the accepted standard of medical practice is the definition of

Correct AnswerverifiedShow Answer

Patients sign an __________ of benefits form so that the physician will receive payment for services directly.

Correct AnswerverifiedShow Answer

Electronic claims are submitted via the internet.

Correct AnswerverifiedShow Answer

Procedures performed on the patient are found in what block?

Correct AnswerverifiedShow Answer

The assignment of benefits is located in block

Correct AnswerverifiedShow Answer

A PAR provider can bill the patient for the difference between their fee and insurance companies allowed amount.

Correct AnswerverifiedShow Answer

The date in block 14 is the date

Correct AnswerverifiedShow Answer

Claims that have errors or omissions that must be corrected and resubmitted to receive reimbursement are called _____________ claims.

Correct AnswerverifiedShow Answer

A secondary health plan is noted in which block?

Correct AnswerverifiedShow Answer

The billing provider's NPI number is placed in block

Correct AnswerverifiedShow Answer

The process of determining if a procedure or service is covered by the insurance plan and what the reimbursement is for that procedure is the definition of

Correct AnswerverifiedShow Answer

Which of the following steps to medical billing should be performed prior to rendering medical services?

Correct AnswerverifiedShow Answer

To settle or determine judicially is the definition of

Correct AnswerverifiedShow Answer

Electronic data interchange is

Correct AnswerverifiedShow Answer

Which of the following is a common reason why insurance claims are rejected?

Correct AnswerverifiedShow Answer

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