Question 1

Which of the following methods can be used to determine a patient's eligibility for insurance?

Accepted Answer

A)   Calling the provider services number on the back of the health insurance ID
B)   Using the provider web portal sponsored by the patient's health insurance company
C)   Both A and B
D)   None of the above

Question 2

Meeting the stipulated requirements to participate in the healthcare plan is the definition of

Accepted Answer

A)   eligibility.
B)   precertification.
C)   medical necessity.
D)   capitation.

Question 3

If the ICD-10-CM codes and the CPT/HCPCS codes do not match the claim will not show __________.

Accepted Answer

A)   eligibility
B)   precertification
C)   medical necessity
D)   capitation

Question 4

Patients belonging to a MCO usually are required to get a referral from their ____ before seeing a specialist.

Accepted Answer

A)   HMO
B)   EPO
C)   PCP
D)   CMS

Question 5

The physician's signature is located in block

Accepted Answer

A)   12.
B)   13.
C)   31.
D)   33.

Question 6

Abuse is knowingly and willfully executing or attempting to execute a scheme to defraud any healthcare benefit program. Fraud is an unintended action that results in an overpayment to the healthcare provider.

Accepted Answer

A)   Both statements are true.
B)   Both statements are false.
C)   The first statement is true and the second statement is false.
D)   The first statement is false and the second statement is true.

Question 7

The medical assistant should __________ the front and back of the patient's insurance card.

Accepted Answer

A)   annotate
B)   highlight
C)   copy
D)   None of the above

Question 8

When completing the CMS-1500 form, which section contains information about the patient and the insured?

Accepted Answer

A)   Section 1
B)   Section 2
C)   Section 3
D)   Section 4

Question 9

How many diagnoses can be reported on the CMS-1500?

Accepted Answer

A)   Four
B)   Eight
C)   Twelve
D)   Sixteen C

Question 10

A set dollar amount that the policyholder must pay before the insurance company starts to pay for services is the definition of

Accepted Answer

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

Question 11

The Federal Tax ID number (Box 25)  for the provider filing the claim can be presented as

Accepted Answer

A)   Social Security Number (SSN) .
B)   Employer Identification Number (EIN) .
C)   National Provider Identification (NPI) .
D)   Both A and B
E)   All of the above

Question 12

A set dollar amount that the patient must pay for each office visit is the definition of

Accepted Answer

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

Question 13

The patient's name is found in block

Accepted Answer

A)   1.
B)   2.
C)   3.
D)   4.

Question 14

When the birthday rule is used to determine which policy is primary and which is secondary, it is the policy of the person who is the oldest that is considered primary.

Accepted Answer

A) True 
 B)False

Question 15

The physician's office place-of-service code is

Accepted Answer

A)   9.
B)   10.
C)   11.
D)   12.

Question 16

The medical assistant should always follow office __________ for claim review and signatures.

Accepted Answer

A)   rules
B)   policies
C)   conventions
D)   directions B

Question 17

The first step in filing a claim with a third-party is

Accepted Answer

A)   verify all charges and fees.
B)   proof read the claim information.
C)   complete the precertification process.
D)   obtain accurate billing information from the patient.

Question 18

Which of the following steps is needed to obtain precertification?

Accepted Answer

A)   Call provider services phone number on the back of the patient's health insurance ID card.
B)   Provide the insurance company with procedures/services requested and the diagnoses.
C)   Document the outcome of the call in the patient's health record.
D)   All of the above D

Question 19

The insured's address in block 7 refers to the __________ address.

Accepted Answer

A)   patient's
B)   spouse's
C)   policyholder's
D)   insurance carrier's

Question 20

To examine claims for accuracy and completeness before they are submitted is to _________ the claims.

Accepted Answer

A)   correct
B)   audit
C)   revise
D)   reject

Exam 26: Billing and Reimbursement

Which of the following methods can be used to determine a patient's eligibility for insurance?

Correct AnswerverifiedShow Answer

Meeting the stipulated requirements to participate in the healthcare plan is the definition of

Correct AnswerverifiedShow Answer

If the ICD-10-CM codes and the CPT/HCPCS codes do not match the claim will not show __________.

Correct AnswerverifiedShow Answer

Patients belonging to a MCO usually are required to get a referral from their ____ before seeing a specialist.

Correct AnswerverifiedShow Answer

The physician's signature is located in block

Correct AnswerverifiedShow Answer

Abuse is knowingly and willfully executing or attempting to execute a scheme to defraud any healthcare benefit program. Fraud is an unintended action that results in an overpayment to the healthcare provider.

Correct AnswerverifiedShow Answer

The medical assistant should __________ the front and back of the patient's insurance card.

Correct AnswerverifiedShow Answer

When completing the CMS-1500 form, which section contains information about the patient and the insured?

Correct AnswerverifiedShow Answer

How many diagnoses can be reported on the CMS-1500?

Correct AnswerverifiedC

A set dollar amount that the policyholder must pay before the insurance company starts to pay for services is the definition of

Correct AnswerverifiedShow Answer

The Federal Tax ID number (Box 25) for the provider filing the claim can be presented as

Correct AnswerverifiedShow Answer

A set dollar amount that the patient must pay for each office visit is the definition of

Correct AnswerverifiedShow Answer

The patient's name is found in block

Correct AnswerverifiedShow Answer

When the birthday rule is used to determine which policy is primary and which is secondary, it is the policy of the person who is the oldest that is considered primary.

Correct AnswerverifiedShow Answer

The physician's office place-of-service code is

Correct AnswerverifiedShow Answer

The medical assistant should always follow office __________ for claim review and signatures.

Correct AnswerverifiedB

The first step in filing a claim with a third-party is

Correct AnswerverifiedShow Answer

Which of the following steps is needed to obtain precertification?

Correct AnswerverifiedD

The insured's address in block 7 refers to the __________ address.

Correct AnswerverifiedShow Answer

To examine claims for accuracy and completeness before they are submitted is to _________ the claims.

Correct AnswerverifiedShow Answer

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified
C

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified
B

Correct Answer
verified

Correct Answer
verified
D

Correct Answer
verified

Correct Answer
verified