Question 1

When following up on a delinquent claim, if the carrier tells you that it is still in process, you should:

Accepted Answer

A)  resubmit the claim by mail 
B)  resubmit the claim by fax 
C)  send the patient a statement 
D)  request an anticipated date of payment 
A)  resubmit the claim by mail 
B)  resubmit the claim by fax 
C)  send the patient a statement 
D)  request an anticipated date of payment D

Question 2

Match each type of information found on an Explanation of Benefits (EOB) form with its definition.
-Number that identifies or refers to the claim that either the patient or the health provider submitted to the insurance company

Accepted Answer

A) patient 
B) insured ID number 
C) claim number 
D) type of service 
E) date of service
F)charge
G)not covered amount
H)total patient cost 
A) patient 
B) insured ID number 
C) claim number 
D) type of service 
E) date of service
F)charge
G)not covered amount
H)total patient cost C

Question 3

Which of the following is not an advantage of using an Electronic Claims Tracking (ECT) system?

Accepted Answer

A)  Claims can be tracked online. 
B)  All claims are guaranteed to be paid if the forms are filled out correctly. 
C)  Far fewer phone calls need to be made to track unpaid claims. 
D)  The use of 24-hour rolling claims problem alerts reduces lost time. 
A)  Claims can be tracked online. 
B)  All claims are guaranteed to be paid if the forms are filled out correctly. 
C)  Far fewer phone calls need to be made to track unpaid claims. 
D)  The use of 24-hour rolling claims problem alerts reduces lost time. B

Question 4

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 5

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 balance
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 balance
Q)secondary insurance

Question 6

Match each term with its definition.
-Patient's signature on a form that permits the release of his or her information, allowing the claim to be filed on his or her behalf

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 balance
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 balance
Q)secondary insurance

Question 7

The CMS-1500 form is accepted by:

Accepted Answer

A)  Medicare 
B)  Medicaid 
C)  both Medicare and Medicaid 
D)  neither Medicare nor Medicaid 
A)  Medicare 
B)  Medicaid 
C)  both Medicare and Medicaid 
D)  neither Medicare nor Medicaid

Question 8

Match each term with its definition.
-Information on this form is collected to ensure credit for full payment, to ensure the patient receives any refunds due, to service public inquiries, and to comply with the Debt Collection Improvement Act of 1996

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 balance
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 balance
Q)secondary insurance

Question 9

How many digits are in a National Provider Identifier (NPI) number?

Accepted Answer

A)  18 
B)  10 
C)  9 
D)  5 
A)  18 
B)  10 
C)  9 
D)  5

Question 10

Match each term with its definition.
-This amount is often shown in parentheses in a patient account

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 balance
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 balance
Q)secondary insurance

Question 11

Match each term with its definition.
-Developed to report the health care provided to the source of payment when third-party reimbursement was created

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 balance
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 balance
Q)secondary insurance

Question 12

Match each term with its definition.
-Use of these allows a medical facility or physician's office to submit transactions faster and be paid sooner

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 balance
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 balance
Q)secondary insurance

Question 13

Manual claims tracking:

Accepted Answer

A)  frequently causes payment delays 
B)  requires minimal effort on the part of office staff 
C)  is both inexpensive and efficient 
D)  is commonly used in most practices today 
A)  frequently causes payment delays 
B)  requires minimal effort on the part of office staff 
C)  is both inexpensive and efficient 
D)  is commonly used in most practices today

Question 14

Match each term with its definition.
-Form or document that may be sent to the patient by their insurance company several months after they have had a healthcare service that was paid by the insurance company

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 balance
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 balance
Q)secondary insurance

Question 15

Match each type of information found on an Explanation of Benefits (EOB) form with its definition.
-Amount a provider billed the patient's insurance company for a service

Accepted Answer

A) patient 
B) insured ID number 
C) claim number 
D) type of service 
E) date of service
F)charge
G)not covered amount
H)total patient cost 
A) patient 
B) insured ID number 
C) claim number 
D) type of service 
E) date of service
F)charge
G)not covered amount
H)total patient cost

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 covered amount
H)total patient cost 
A) patient 
B) insured ID number 
C) claim number 
D) type of service 
E) date of service
F)charge
G)not covered amount
H)total patient cost

Question 17

When applying an insurance adjustment to a patient's account, you are not typically required to post the:

Accepted Answer

A)  name of the insurance company making the adjustment 
B)  name of the secondary insurance company that might be billed later 
C)  amount of the adjustment 
D)  date of the adjustment 
A)  name of the insurance company making the adjustment 
B)  name of the secondary insurance company that might be billed later 
C)  amount of the adjustment 
D)  date of the adjustment

Question 18

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 19

Match each term with its definition.
-Standard claim form used for billing in medical offices

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 balance
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 balance
Q)secondary insurance

Question 20

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.

Exam 17: The Immune System

When following up on a delinquent claim, if the carrier tells you that it is still in process, you should:

Match each type of information found on an Explanation of Benefits (EOB) form with its definition. -Number that identifies or refers to the claim that either the patient or the health provider submitted to the insurance company

Which of the following is not an advantage of using an Electronic Claims Tracking (ECT) system?

Electronically processing claim forms to insurance carriers:

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. -Patient's signature on a form that permits the release of his or her information, allowing the claim to be filed on his or her behalf

The CMS-1500 form is accepted by:

Match each term with its definition. -Information on this form is collected to ensure credit for full payment, to ensure the patient receives any refunds due, to service public inquiries, and to comply with the Debt Collection Improvement Act of 1996

How many digits are in a National Provider Identifier (NPI) number?

Match each term with its definition. -This amount is often shown in parentheses in a patient account

Match each term with its definition. -Developed to report the health care provided to the source of payment when third-party reimbursement was created

Match each term with its definition. -Use of these allows a medical facility or physician's office to submit transactions faster and be paid sooner

Manual claims tracking:

Match each term with its definition. -Form or document that may be sent to the patient by their insurance company several months after they have had a healthcare service that was paid by the insurance company

Match each type of information found on an Explanation of Benefits (EOB) form with its definition. -Amount a provider billed the patient's insurance company for a service

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

When applying an insurance adjustment to a patient's account, you are not typically required to post the:

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

Match each term with its definition. -Standard claim form used for billing in medical offices

What is the first step in completing a claim form?

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 Digestive System

The Urinary System

The Endocrine System

The Reproductive System

Telephone Communications

Written Communications

Operating Computers and Office Equipment

Scheduling Appointments and Receiving Patients

The Medical Record, Documentation, and Filing

Health Insurance

Procedural and Diagnostic Coding

Patient Accounts

Preparing Insurance Claims and Posting Insurance Payments

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

Maintaining the Office Environment

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