Question 1

TRICARE appeals are normally resolved within

Accepted Answer

A)  2 weeks. 
B)  30 days. 
C)  60 days. 
D)  90 days. 
A)  2 weeks. 
B)  30 days. 
C)  60 days. 
D)  90 days.

Question 2

If you have a denied insurance claim, you should change the information and resubmit the claim.

Accepted Answer

A) True 
 B)False

Question 3

In the case of a Medicare Part B redetermination, carriers have been instructed to pay an appealed insurance claim if the cost of the hearing process is more than the amount of the claim.

Accepted Answer

A) True 
 B)False

Question 4

The document together with the payment voucher that is sent to a physician who has accepted assignment of benefits is referred to as an

Accepted Answer

A)  EOB. 
B)  EOMB. 
C)  MRA. 
D)  MPS. 
A)  EOB. 
B)  EOMB. 
C)  MRA. 
D)  MPS.

Question 5

What should be done if an insurance claim denial is received because a billed service was not a program benefit?

Accepted Answer

A)  Rebill with a letter of explanation from the physician. 
B)  Write-off the amount on the patient's ledger. 
C)  Send the patient a statement with a notation of the response from the insurance company. 
D)  Appeal the decision with a statement from the physician. 
A)  Rebill with a letter of explanation from the physician. 
B)  Write-off the amount on the patient's ledger. 
C)  Send the patient a statement with a notation of the response from the insurance company. 
D)  Appeal the decision with a statement from the physician.

Question 6

If inadequate payment was received from an insurance company for a complicated procedure, the insurance billing specialist should file a/an ____________________ on behalf of the physician.

Accepted Answer

The answer of If inadequate payment was received from an...

Question 7

An example of a technical error on an insurance claim is

Accepted Answer

A)  duplicate dates of service. 
B)  transposed numbers. 
C)  missing place of service code. 
D)  all of the above. 
A)  duplicate dates of service. 
B)  transposed numbers. 
C)  missing place of service code. 
D)  all of the above.

Question 8

There is standardization of format for the explanation of benefits document for all private insurance carriers.

Accepted Answer

A) True 
 B)False

Question 9

In any type of overpayment situation, always cash the third-party payers check and write a refund check payable to the originator of the overpayment.

Accepted Answer

A) True 
 B)False

Question 10

An insured person cannot bring legal action against an insurance company until ____________________ days after a claim is submitted to the insurance company.

Accepted Answer

The answer of An insured person cannot bring legal action...

Question 11

The insurance payment poster is responsible for submitting appeals for denied claims.

Accepted Answer

A) True 
 B)False

Question 12

A follow-up effort made to an insurance company to locate the status of an insurance claim is called a/an

Accepted Answer

A)  inquiry. 
B)  tracer. 
C)  rebill. 
D)  both a and b 
A)  inquiry. 
B)  tracer. 
C)  rebill. 
D)  both a and b

Question 13

How many levels of review exist for TRICARE appeal procedures?

Accepted Answer

A)  One 
B)  Two 
C)  Three 
D)  Five 
A)  One 
B)  Two 
C)  Three 
D)  Five

Question 14

A request for a hearing before an administrative law judge (in a Medicare case) may be made if the amount still in question is ____________________ or more.

Accepted Answer

The answer of A request for a hearing before an...

Question 15

Time limits stated in individual health insurance policies about an insurance company's obligation to pay benefits are the same for all insurance companies.

Accepted Answer

A) True 
 B)False

Question 16

The first level of appeal in the Medicare program is

Accepted Answer

A)  redetermination. 
B)  inquiry. 
C)  fair hearing. 
D)  appeals council review. 
A)  redetermination. 
B)  inquiry. 
C)  fair hearing. 
D)  appeals council review.

Question 17

The management of health insurance claims by paper and electronically are the same.

Accepted Answer

A) True 
 B)False

Question 18

If an insurance claim has been lost by the insurance carrier, the procedure(s) to follow is to

Accepted Answer

A)  ask if there is a backlog of claims at the insurance office. 
B)  submit a copy of the original claim. 
C)  verify the correct mailing address. 
D)  all of the above. 
A)  ask if there is a backlog of claims at the insurance office. 
B)  submit a copy of the original claim. 
C)  verify the correct mailing address. 
D)  all of the above.

Question 19

An insurance claim for a service that has been bundled with other services would be

Accepted Answer

A)  paid. 
B)  rejected. 
C)  suspended. 
D)  denied. 
A)  paid. 
B)  rejected. 
C)  suspended. 
D)  denied.

Question 20

An insurance claim that is pending because of the need for additional information is also referred to as being in ____________________.

Accepted Answer

The answer of An insurance claim that is pending because...

TRICARE appeals are normally resolved within

If you have a denied insurance claim, you should change the information and resubmit the claim.

In the case of a Medicare Part B redetermination, carriers have been instructed to pay an appealed insurance claim if the cost of the hearing process is more than the amount of the claim.

The document together with the payment voucher that is sent to a physician who has accepted assignment of benefits is referred to as an

What should be done if an insurance claim denial is received because a billed service was not a program benefit?

If inadequate payment was received from an insurance company for a complicated procedure, the insurance billing specialist should file a/an ____________________ on behalf of the physician.

An example of a technical error on an insurance claim is

There is standardization of format for the explanation of benefits document for all private insurance carriers.

In any type of overpayment situation, always cash the third-party payers check and write a refund check payable to the originator of the overpayment.

An insured person cannot bring legal action against an insurance company until ____________________ days after a claim is submitted to the insurance company.

The insurance payment poster is responsible for submitting appeals for denied claims.

A follow-up effort made to an insurance company to locate the status of an insurance claim is called a/an

How many levels of review exist for TRICARE appeal procedures?

A request for a hearing before an administrative law judge (in a Medicare case) may be made if the amount still in question is ____________________ or more.

Time limits stated in individual health insurance policies about an insurance company's obligation to pay benefits are the same for all insurance companies.

The first level of appeal in the Medicare program is

The management of health insurance claims by paper and electronically are the same.

If an insurance claim has been lost by the insurance carrier, the procedure(s) to follow is to

An insurance claim for a service that has been bundled with other services would be

An insurance claim that is pending because of the need for additional information is also referred to as being in ____________________.

Role of an Insurance Billing Specialist

Compliance, Privacy, Fraud, and Abuse in Insurance Billing

Basics of Health Insurance

Medical Documentation and the Electronic Health Record

Diagnostic Coding

Procedural Coding

The Paper Claim: Cms-1500 02-12

The Electronic Claim

Office and Insurance Collection Strategies

The Blue Plans, Private Insurance, and Managed Care Plans

Medicare

Medicaid and Other State Programs

Tricare and Veterans Health Care

Workers Compensation

Disability Income Insurance and Disability Benefit Programs

Hospital Billing

Seeking a Job and Attaining Professional Advancement

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Exam 9: Receiving Payments and Insurance Problem Solving

TRICARE appeals are normally resolved within

If you have a denied insurance claim, you should change the information and resubmit the claim.

In the case of a Medicare Part B redetermination, carriers have been instructed to pay an appealed insurance claim if the cost of the hearing process is more than the amount of the claim.

The document together with the payment voucher that is sent to a physician who has accepted assignment of benefits is referred to as an

What should be done if an insurance claim denial is received because a billed service was not a program benefit?

If inadequate payment was received from an insurance company for a complicated procedure, the insurance billing specialist should file a/an ____________________ on behalf of the physician.

An example of a technical error on an insurance claim is

There is standardization of format for the explanation of benefits document for all private insurance carriers.

In any type of overpayment situation, always cash the third-party payers check and write a refund check payable to the originator of the overpayment.

An insured person cannot bring legal action against an insurance company until ____________________ days after a claim is submitted to the insurance company.

The insurance payment poster is responsible for submitting appeals for denied claims.

A follow-up effort made to an insurance company to locate the status of an insurance claim is called a/an

How many levels of review exist for TRICARE appeal procedures?

A request for a hearing before an administrative law judge (in a Medicare case) may be made if the amount still in question is ____________________ or more.

Time limits stated in individual health insurance policies about an insurance company's obligation to pay benefits are the same for all insurance companies.

The first level of appeal in the Medicare program is

The management of health insurance claims by paper and electronically are the same.

If an insurance claim has been lost by the insurance carrier, the procedure(s) to follow is to

An insurance claim for a service that has been bundled with other services would be

An insurance claim that is pending because of the need for additional information is also referred to as being in ____________________.

Role of an Insurance Billing Specialist

Compliance, Privacy, Fraud, and Abuse in Insurance Billing

Basics of Health Insurance

Medical Documentation and the Electronic Health Record

Diagnostic Coding

Procedural Coding

The Paper Claim: Cms-1500 02-12

The Electronic Claim

Office and Insurance Collection Strategies

The Blue Plans, Private Insurance, and Managed Care Plans

Medicare

Medicaid and Other State Programs

Tricare and Veterans Health Care

Workers Compensation

Disability Income Insurance and Disability Benefit Programs

Hospital Billing

Seeking a Job and Attaining Professional Advancement

Filters