Question 1

Which of the following is not a fee usually charged by a clearinghouse?

Accepted Answer

A)  start-up fee 
B)  flat monthly fee 
C)  customer service fee 
D)  per-claim transaction fee 
A)  start-up fee 
B)  flat monthly fee 
C)  customer service fee 
D)  per-claim transaction fee

Question 2

​Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once.
-​When a person or company knowingly deceives Medicare as an intentional act to receive inappropriate payment from the program

Accepted Answer

A) ​fraud 
B) ​abuse 
A) ​fraud 
B) ​abuse

Question 3

Match each term with its definition.
-Paper claim form that may be submitted by an institutional provider that meets certain requirements

Accepted Answer

A) bartered goods 
B) claim form 
C) third-party reimbursers 
D) CMS-1500 
E) CMS-1450
F)Explanation of Benefits (EO
B) form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASC
A) 
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance 
A) bartered goods 
B) claim form 
C) third-party reimbursers 
D) CMS-1500 
E) CMS-1450
F)Explanation of Benefits (EO
B) form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASC
A) 
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance

Question 4

Match each term with its definition.
-These give you immediate access to the status of a claim or group of claims

Accepted Answer

A) bartered goods 
B) claim form 
C) third-party reimbursers 
D) CMS-1500 
E) CMS-1450
F)Explanation of Benefits (EO
B) form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASC
A) 
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance 
A) bartered goods 
B) claim form 
C) third-party reimbursers 
D) CMS-1500 
E) CMS-1450
F)Explanation of Benefits (EO
B) form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASC
A) 
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance

Question 5

​Which of the following is not a common claim error?

Accepted Answer

A)  ​use of correct ICD codes or ICD codes that support the CPT codes 
B)  ​the patient's-not the policy holder's-Social Security number or identification number used as the insurance plan ID number 
C)  ​use of an incorrect national provider identifier (NPI) 
D)  ​the Coordination of Benefits section not completed 
A)  ​use of correct ICD codes or ICD codes that support the CPT codes 
B)  ​the patient's-not the policy holder's-Social Security number or identification number used as the insurance plan ID number 
C)  ​use of an incorrect national provider identifier (NPI) 
D)  ​the Coordination of Benefits section not completed

Question 6

​Match the type of insurance to its description.Note: Answers may be used more than once.
-​Patients are responsible for any part of the provider's fee that the insurance does not pay

Accepted Answer

A) ​IPA 
B) ​HMO 
C) ​PPO 
A) ​IPA 
B) ​HMO 
C) ​PPO

Question 7

​When claim form errors are identified by the third-party payers,the claim is then rejected.Which of the following is not considered an error?

Accepted Answer

A)  ​the correct place of service code 
B)  ​the sex of the patient is missing 
C)  ​a patient's nickname is used instead of his or her legal name (i.e. ,Bob instead of Robert) 
D)  ​incorrect patient birth date 
A)  ​the correct place of service code 
B)  ​the sex of the patient is missing 
C)  ​a patient's nickname is used instead of his or her legal name (i.e. ,Bob instead of Robert) 
D)  ​incorrect patient birth date

Question 8

When a third-party payer identifies an error on the claim form,the claim is:

Accepted Answer

A)  rejected with a request to resubmit the form with corrections 
B)  rejected and barred from resubmission 
C)  paid,with a penalty fee subtracted for the error 
D)  held indefinitely until the medical office calls to inquire about its status 
A)  rejected with a request to resubmit the form with corrections 
B)  rejected and barred from resubmission 
C)  paid,with a penalty fee subtracted for the error 
D)  held indefinitely until the medical office calls to inquire about its status

Question 9

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once.
-​Office cost is reduced by eliminating the need for stamps,forms,and excess office staff labor

Accepted Answer

A) ​manual claims tracking 
B) ​electronic claims tracking 
A) ​manual claims tracking 
B) ​electronic claims tracking

Question 10

Match each term with its definition.
-In many instances,this will pay most,if not all,of the balance left over from the primary insurance to your physician and will leave little out-of-pocket expenses for the patient

Accepted Answer

A) bartered goods 
B) claim form 
C) third-party reimbursers 
D) CMS-1500 
E) CMS-1450
F)Explanation of Benefits (EO
B) form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASC
A) 
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance 
A) bartered goods 
B) claim form 
C) third-party reimbursers 
D) CMS-1500 
E) CMS-1450
F)Explanation of Benefits (EO
B) form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASC
A) 
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance

Question 11

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once.
-​Results can be viewed easily on a computer screen and information printed as needed

Accepted Answer

A) ​manual claims tracking 
B) ​electronic claims tracking 
A) ​manual claims tracking 
B) ​electronic claims tracking

Question 12

What is the first step in completing a claim form?

Accepted Answer

A)  Check to see if the patient's signature is on file for release of information. 
B)  Write the provider's federal tax ID number in the appropriate space. 
C)  Correctly complete boxes 1-3 on the form. 
D)  Check for a photocopy of the patient's insurance card. 
A)  Check to see if the patient's signature is on file for release of information. 
B)  Write the provider's federal tax ID number in the appropriate space. 
C)  Correctly complete boxes 1-3 on the form. 
D)  Check for a photocopy of the patient's insurance card.

Question 13

The phrase _____ was coined to indicate payment of services rendered by someone other than the patient.

Accepted Answer

A)  health care provider 
B)  health maintenance organization 
C)  third-party reimbursement 
D)  two-party system 
A)  health care provider 
B)  health maintenance organization 
C)  third-party reimbursement 
D)  two-party system

Question 14

Electronically processing claim forms to insurance carriers:

Accepted Answer

A)  lengthens the turnaround time 
B)  reduces the amount of preparation time for the claims processor 
C)  is discouraged because of the danger of violating HIPAA 
D)  is more expensive than traditional manual claims processing 
A)  lengthens the turnaround time 
B)  reduces the amount of preparation time for the claims processor 
C)  is discouraged because of the danger of violating HIPAA 
D)  is more expensive than traditional manual claims processing

Question 15

Match each term with its definition.
-Similar to the EOB but is the document provided by the pater to the provider

Accepted Answer

A) bartered goods 
B) claim form 
C) third-party reimbursers 
D) CMS-1500 
E) CMS-1450
F)Explanation of Benefits (EO
B) form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASC
A) 
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance 
A) bartered goods 
B) claim form 
C) third-party reimbursers 
D) CMS-1500 
E) CMS-1450
F)Explanation of Benefits (EO
B) form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASC
A) 
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance

Question 16

Match each type of information found on an Explanation of Benefits (EOB)form with its definition.
-Number assigned to a patient by the insurance company,which should match the number on the patient's insurance card

Accepted Answer

A) patient 
B) insured ID number 
C) claim number 
D) type of service 
E) date of service
F)charge
G)not allowed amount
H)coinsurance co-payment amount 
A) patient 
B) insured ID number 
C) claim number 
D) type of service 
E) date of service
F)charge
G)not allowed amount
H)coinsurance co-payment amount

Question 17

Match each type of information found on an Explanation of Benefits (EOB)form with its definition.
-Name of the person who received the service

Accepted Answer

A) patient 
B) insured ID number 
C) claim number 
D) type of service 
E) date of service
F)charge
G)not allowed amount
H)coinsurance co-payment amount 
A) patient 
B) insured ID number 
C) claim number 
D) type of service 
E) date of service
F)charge
G)not allowed amount
H)coinsurance co-payment amount

Question 18

Match each term with its definition.
-Type of payment used for centuries in the past

Accepted Answer

A) bartered goods 
B) claim form 
C) third-party reimbursers 
D) CMS-1500 
E) CMS-1450
F)Explanation of Benefits (EO
B) form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASC
A) 
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance 
A) bartered goods 
B) claim form 
C) third-party reimbursers 
D) CMS-1500 
E) CMS-1450
F)Explanation of Benefits (EO
B) form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASC
A) 
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance

Question 19

Match each term with its definition.
-Private or public company that often serves as the middleman between providers and billing groups,payers,and other health care partners for the transmission and translation of electronic claims information into the specific format required by payers

Accepted Answer

A) bartered goods 
B) claim form 
C) third-party reimbursers 
D) CMS-1500 
E) CMS-1450
F)Explanation of Benefits (EO
B) form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASC
A) 
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance 
A) bartered goods 
B) claim form 
C) third-party reimbursers 
D) CMS-1500 
E) CMS-1450
F)Explanation of Benefits (EO
B) form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASC
A) 
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance

Question 20

​The primary insurance information will be placed in _______ of the CMS-1500 form for secondary billing.

Accepted Answer

A)  ​Block 9 
B)  the ​[Reserved for NUCC use] block 
C)  ​the FECA number block 
D)  ​the resubmission code block 
A)  ​Block 9 
B)  the ​[Reserved for NUCC use] block 
C)  ​the FECA number block 
D)  ​the resubmission code block

Exam 31: Preparing Insurance Claims and Posting Insurance Payments

Which of the following is not a fee usually charged by a clearinghouse?

​Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once. -​When a person or company knowingly deceives Medicare as an intentional act to receive inappropriate payment from the program

Match each term with its definition. -Paper claim form that may be submitted by an institutional provider that meets certain requirements

Match each term with its definition. -These give you immediate access to the status of a claim or group of claims

​Which of the following is not a common claim error?

​Match the type of insurance to its description.Note: Answers may be used more than once. -​Patients are responsible for any part of the provider's fee that the insurance does not pay

​When claim form errors are identified by the third-party payers,the claim is then rejected.Which of the following is not considered an error?

When a third-party payer identifies an error on the claim form,the claim is:

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -​Office cost is reduced by eliminating the need for stamps,forms,and excess office staff labor

Match each term with its definition. -In many instances,this will pay most,if not all,of the balance left over from the primary insurance to your physician and will leave little out-of-pocket expenses for the patient

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -​Results can be viewed easily on a computer screen and information printed as needed

What is the first step in completing a claim form?

The phrase _____ was coined to indicate payment of services rendered by someone other than the patient.

Electronically processing claim forms to insurance carriers:

Match each term with its definition. -Similar to the EOB but is the document provided by the pater to the provider

Match each type of information found on an Explanation of Benefits (EOB)form with its definition. -Number assigned to a patient by the insurance company,which should match the number on the patient's insurance card

Match each type of information found on an Explanation of Benefits (EOB)form with its definition. -Name of the person who received the service

Match each term with its definition. -Type of payment used for centuries in the past

Match each term with its definition. -Private or public company that often serves as the middleman between providers and billing groups,payers,and other health care partners for the transmission and translation of electronic claims information into the specific format required by payers

​The primary insurance information will be placed in _______ of the CMS-1500 form for secondary billing.

The Medical Assistant

The Health Care Team and the Medical Environment,past and Present

Legal Issues

Ethical Issues

Verbal and Nonverbal Communications

Applying Communication Skills

Introduction to Medical Terminology

Understanding and Building Medical Terms of Body Systems

Anatomic Descriptors and Fundamental Body Structure

The Nervous System

The Senses

The Integumentary System

The Skeletal System

The Muscular System

The Respiratory System

The Circulatory System

The Immune System

The Digestive System

The Urinary System

The Endocrine System

The Reproductive System

Telephone Communications

Written Communications

The Office Environment, computers, and Equipment

Scheduling Appointments and Receiving Patients

The Medical Record,documentation,and Filing

Health Insurance

A Icd-10 Update: Procedural and Diagnostic Coding

Procedural and Diagnostic Coding

Patient Accounts

Patient Billing,posting Patient Payments,and Collecting Fees

Banking Procedures

Accounts Payable and Accounting Procedures

Infection Control and Medical Asepsis

The Medical History and Patient Screening

Body Measurements and Vital Signs

Preparing for Examinations

The Physical Exam

Specialty Exams and Other Procedures

Obgyn Examinations

Pediatric Examinations

The Physicians Office Laboratory

Specimen Collection and Processing

Blood Specimen Collection

Diagnostic Testing

Cardiology Procedures

Radiology Procedures

Preparing for Surgery

Assisting With Minor Surgery

Pharmacology Fundamentals

Measurement Systems,basic Mathematics,and Dosage Calculations

Administering Oral and Non-Injectable Medications

Administering Injections and Immunizations

Emergencies in the Medical Office and the Community

First Aid for Accidents and Injuries

Rehabilitation

Nutrition,exercise,and Healthy Living

Practicum and the Job Search

Managing the Office

Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once. -When a person or company knowingly deceives Medicare as an intentional act to receive inappropriate payment from the program

Which of the following is not a common claim error?

Match the type of insurance to its description.Note: Answers may be used more than once. -Patients are responsible for any part of the provider's fee that the insurance does not pay

When claim form errors are identified by the third-party payers,the claim is then rejected.Which of the following is not considered an error?

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -Office cost is reduced by eliminating the need for stamps,forms,and excess office staff labor

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -Results can be viewed easily on a computer screen and information printed as needed

The primary insurance information will be placed in _______ of the CMS-1500 form for secondary billing.