1. If the insurance plan has a hold harmless clause, it means that the patient
a.
is charged for fees by the health care provider, per the EOB.
b.
automatically has lower out-of-pocket health care expenses.
c.
is not responsible for paying what the insurance plan denies.
d.
was required to pay any amounts that the insurance plan denies.
ANSWER:
c
POINTS:
1
QUESTION TYPE:
Multiple Choice
HAS VARIABLES:
False
DATE CREATED:
7/19/2019 2:53 PM
DATE MODIFIED:
9/16/2019 5:28 AM
2. The process of reporting __________ as numeric and alphanumeric characters on the insurance claim is called coding.
dates of service for procedures
diagnoses and procedures/services
health insurance claims identifiers
national provider identifiers
b
9/16/2019 5:30 AM
3. A claims examiner employed by a third-party payer reviews health-related claims to determine whether the charges are reasonable, in addition to
assigning ICD-10-CM and CPT codes.
billing patients for copayments and coinsurance.
determining medical necessity of services/procedures.
resubmitting denied claims to health care providers.
9/16/2019 5:33 AM
4. Which is another name for a health insurance specialist?
billing specialist
coding specialist
health information specialist
reimbursement specialist
d
9/16/2019 5:35 AM
5. A claims examiner is employed by a
facility to submit claims.
governmental agency to process claims.
physician’s office to submit claims.
third-party payer to review claims.
9/16/2019 5:36 AM
6. Which involves linking every procedure or service code reported on the claim to a condition code that justifies the necessity of performing that procedure or service?
claims adjudication
diagnosis coding
medical necessity
reimbursement processing
9/16/2019 5:38 AM
7. The CPT manual is published by the
American Billing Association.
American Board of Physicians.
American Dental Association.
American Medical Association.
9/16/2019 5:39 AM
8. Which is submitted to the payer requesting reimbursement?
explanation of benefits
health insurance claim
remittance advice
prior approval form
9/16/2019 5:40 AM
9. The Centers for Medicare and Medicaid Services (CMS) agency is located in the __________.
ACF
DHHS
FDA
OIG
9/16/2019 5:42 AM
10. When a health insurance plan’s prior approval requirements are not met by providers,
administrative costs are reduced.
patients’ coverage is canceled.
payment of the claim is denied.
providers pay a fine to the plan.
9/16/2019 5:45 AM
11. Which coding system is used to report procedures and services on claims?
CPT
ICD-10-CM
SNDO
SNOMED
a
9/16/2019 6:13 AM
12. Which would be found on a remittance advice?
detected errors and omissions from claims
documentation of medical necessity
payment information about a claim
provider qualifications and responsibilities
9/16/2019 6:16 AM
13. Which guarantees repayment for financial losses resulting from an employee’s act or failure to act?
bonding insurance
liability insurance
property insurance
workers’ compensation insurance
9/16/2019 6:18 AM
14. Medical malpractice insurance is which type of insurance?
bonding
liability
property
workers’ compensation
9/16/2019 6:19 AM
15. Which type of insurance covers employees and their dependents against injury and death that occurs during the course of employment?
9/16/2019 6:32 AM
16. The word embezzle means to _____.
compensate
disburse
remunerate
steal
9/16/2019 6:34 AM
17. Independent contractors should purchase __________ liability insurance, which provides protection from liability as a result of errors and omissions when performing their professional services.
business
professional
9/16/2019 6:44 AM
18. Which term describes the principles of right or good conduct and includes rules that govern the conduct of members
of a profession?
biased
ethics
immoral
misleading
19. The Healthcare Common Procedure Coding System (HCPCS) consists of __________ codes.
CPT and national
DSM and CDT
ICD-10-CM and ICD-10-PCS
SNOMED and SNDO
20. Health information technicians _____.
assist with direct patient care
document clinical information
manage medical records
process health insurance claims
9/16/2019 6:45 AM
21. The organization that hires a(n) __________ is not liable for the acts or omissions of that individual.
health insurance specialist
health care provider
independent contractor
medical assistant
9/16/2019 6:46 AM
22. During completion of a student internship, the facility will likely require students to sign a nondisclosure agreement to
protect __________.
facility resources
health care finances
patient confidentiality
quality of patient care
23. Which coding system is used to report procedures and services on inpatient hospital claims?
HCPCS level II
ICD-10-PCS
9/16/2019 6:47 AM
24. Which does a provider usually employ to perform administrative and clinical tasks, which help keep the office or clinic
running smoothly?
health information technician
nurse practitioner
25. Which organization offers the CPB exam?
AAPC
AHIMA
AMBA
CMS
9/20/2019 4:57 AM
26. Which are published by CMS and used to report procedures, services, and supplies not classified in CPT?
dental codes
disease codes
injury codes
national codes
9/16/2019 6:49 AM
27. Conduct or qualities that characterize a professional person are called __________.
certification
credentials
professionalism
specialization
9/16/2019 6:50 AM
28. Which is an insurance agreement that protects business contents against fire, theft, and other risks?
business liability insurance
errors and omissions insurance
29. Which is Latin for “let the master answer,” which means that the employer is liable for the actions and omissions of
employees as performed and committed within the scope of their employment?
res gestae
res ipsa loquitur
respondeat superior
requiescat in pace
9/16/2019 6:51 AM
30. Which defines a profession, delineates qualifications and responsibilities, and clarifies supervision requirements?
job description
policy and procedure
scope of practice
workforce development
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