Question 1

In a TRICARE case, a request for an independent hearing may be pursued if the amount in question is

Accepted Answer

A)  $100 or more. 
B)  $300 or more. 
C)  $500 or more. 
D)  $1000 or more. 
A)  $100 or more. 
B)  $300 or more. 
C)  $500 or more. 
D)  $1000 or more.

Question 2

All of the following are responsibilities of the insurance payment poster EXCEPT:

Accepted Answer

A)  posting insurance reimbursements for every code submitted in the insurance claim. 
B)  adjusting the amount charged to match the allowable charge. 
C)  filing the appeal for denial. 
D)  sending statements for patient deductibles and coinsurance balances. 
A)  posting insurance reimbursements for every code submitted in the insurance claim. 
B)  adjusting the amount charged to match the allowable charge. 
C)  filing the appeal for denial. 
D)  sending statements for patient deductibles and coinsurance balances.

Question 3

All requests of the insurance commissioner must be submitted in writing and include the ____________________ signature.

Accepted Answer

The answer of All requests of the insurance commissioner must...

Question 4

For Medicare patients whose secondary insurance is Medicaid:

Accepted Answer

A)  Medicaid is billed separately. 
B)  Medicare reimburses both the primary and secondary payments. 
C)  The balance is adjusted because the Medicaid fee schedule is less than Medicare. 
D)  The patient is sent a statement for the secondary insurance balance. 
A)  Medicaid is billed separately. 
B)  Medicare reimburses both the primary and secondary payments. 
C)  The balance is adjusted because the Medicaid fee schedule is less than Medicare. 
D)  The patient is sent a statement for the secondary insurance balance.

Question 5

What should be done if an insurance company denies a service stating it was not medically necessary and the physician believes it was?

Accepted Answer

A)  Rebill with a letter of explanation from the physician. 
B)  Write-off the amount on the patient's account. 
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 account. 
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

Appeal decisions on Medicare unassigned insurance claims are sent to the patient.

Accepted Answer

A) True 
 B)False

Question 7

The ______________________ manages complaints about delays in settling insurance claims, illegal cancellations or terminations of an insurance policy, and problems about insurance premium rates.

Accepted Answer

insurance

Question 8

Approximately 50% of individuals pursue appeals on a denied insurance claim.

Accepted Answer

A) True 
 B)False

Question 9

If a payment problem develops with an insurance company and the company ignores claims and exceeds time limits to pay a claim, it is prudent to contact the

Accepted Answer

A)  federal insurance commissioner. 
B)  state insurance commissioner. 
C)  state insurance federation. 
D)  department of public service. 
A)  federal insurance commissioner. 
B)  state insurance commissioner. 
C)  state insurance federation. 
D)  department of public service.

Question 10

If the insurance company inadvertently paid the patient even though there was an assignment of benefits on file, the physician must file a complaint with the state commissioner.

Accepted Answer

A) True 
 B)False

Question 11

Generally, if a bill has not been paid, the physician rebills the patient every ____________________ days.

Accepted Answer

The answer of Generally, if a bill has not been...

Question 12

There are several ways to file pending insurance claims. What is the best way to file so that timely follow-up can be made?

Accepted Answer

A)  File by patient's last name. 
B)  File by type of insurance. 
C)  File by patient's account number. 
D)  File by month of service. 
A)  File by patient's last name. 
B)  File by type of insurance. 
C)  File by patient's account number. 
D)  File by month of service.

Question 13

Documentation from private insurance carriers sent to participating providers that accompanies payment and describes the response to a claim is referred to by the acronym ____________________.

Accepted Answer

The answer of Documentation from private insurance carriers sent to...

Question 14

If an insurance company admits that a patient signed an assignment of benefits document and that it inadvertently paid the patient instead of the physician, the insurance company should

Accepted Answer

A)  advise the physician to write-off the amount as a bad debt. 
B)  pay the physician within 2-3 weeks and honor the assignment even before the company recovers its money from the patient. 
C)  pay the physician within 2-3 weeks after recovering the money from the patient. 
D)  notify the physician of the error and indicate in a letter that it will never happen again. 
A)  advise the physician to write-off the amount as a bad debt. 
B)  pay the physician within 2-3 weeks and honor the assignment even before the company recovers its money from the patient. 
C)  pay the physician within 2-3 weeks after recovering the money from the patient. 
D)  notify the physician of the error and indicate in a letter that it will never happen again.

Question 15

An insurance claims register provides a

Accepted Answer

A)  file containing the name and address of all insurance companies. 
B)  follow-up report that is sent to the insurance commissioner. 
C)  follow-up procedure for insurance claims. 
D)  practice analysis. 
A)  file containing the name and address of all insurance companies. 
B)  follow-up report that is sent to the insurance commissioner. 
C)  follow-up procedure for insurance claims. 
D)  practice analysis.

Question 16

Which of the following is a benefit to using the online health insurance provider web portal?

Accepted Answer

A)  Saves time by eliminating the need to telephone insurance company for every patient 
B)  Supports HIPAA standards of patient privacy and security 
C)  Interacts with EHR systems in downloading directly into patient medical record 
D)  All of the above 
A)  Saves time by eliminating the need to telephone insurance company for every patient 
B)  Supports HIPAA standards of patient privacy and security 
C)  Interacts with EHR systems in downloading directly into patient medical record 
D)  All of the above

Question 17

A peer review is usually done before the appeal process.

Accepted Answer

A) True 
 B)False

Question 18

The insurance industry is protected by a special exemption from the Federal Trade Commission (FTC).

Accepted Answer

A) True 
 B)False

Question 19

An insurance claim with an invalid procedure code would be

Accepted Answer

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

Question 20

The correct method to send documents for a Medicare reconsideration (Level 2) is by

Accepted Answer

A)  certified mail with return receipt requested. 
B)  certified mail. 
C)  standard mail. 
D)  overnight mail. 
A)  certified mail with return receipt requested. 
B)  certified mail. 
C)  standard mail. 
D)  overnight mail.

In a TRICARE case, a request for an independent hearing may be pursued if the amount in question is

All of the following are responsibilities of the insurance payment poster EXCEPT:

All requests of the insurance commissioner must be submitted in writing and include the ____________________ signature.

For Medicare patients whose secondary insurance is Medicaid:

What should be done if an insurance company denies a service stating it was not medically necessary and the physician believes it was?

Appeal decisions on Medicare unassigned insurance claims are sent to the patient.

The ______________________ manages complaints about delays in settling insurance claims, illegal cancellations or terminations of an insurance policy, and problems about insurance premium rates.

Approximately 50% of individuals pursue appeals on a denied insurance claim.

If a payment problem develops with an insurance company and the company ignores claims and exceeds time limits to pay a claim, it is prudent to contact the

If the insurance company inadvertently paid the patient even though there was an assignment of benefits on file, the physician must file a complaint with the state commissioner.

Generally, if a bill has not been paid, the physician rebills the patient every ____________________ days.

There are several ways to file pending insurance claims. What is the best way to file so that timely follow-up can be made?

Documentation from private insurance carriers sent to participating providers that accompanies payment and describes the response to a claim is referred to by the acronym ____________________.

If an insurance company admits that a patient signed an assignment of benefits document and that it inadvertently paid the patient instead of the physician, the insurance company should

An insurance claims register provides a

Which of the following is a benefit to using the online health insurance provider web portal?

A peer review is usually done before the appeal process.

The insurance industry is protected by a special exemption from the Federal Trade Commission (FTC).

An insurance claim with an invalid procedure code would be

The correct method to send documents for a Medicare reconsideration (Level 2) is by

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

In a TRICARE case, a request for an independent hearing may be pursued if the amount in question is

All of the following are responsibilities of the insurance payment poster EXCEPT:

All requests of the insurance commissioner must be submitted in writing and include the ____________________ signature.

For Medicare patients whose secondary insurance is Medicaid:

What should be done if an insurance company denies a service stating it was not medically necessary and the physician believes it was?

Appeal decisions on Medicare unassigned insurance claims are sent to the patient.

The ______________________ manages complaints about delays in settling insurance claims, illegal cancellations or terminations of an insurance policy, and problems about insurance premium rates.

Approximately 50% of individuals pursue appeals on a denied insurance claim.

If a payment problem develops with an insurance company and the company ignores claims and exceeds time limits to pay a claim, it is prudent to contact the

If the insurance company inadvertently paid the patient even though there was an assignment of benefits on file, the physician must file a complaint with the state commissioner.

Generally, if a bill has not been paid, the physician rebills the patient every ____________________ days.

There are several ways to file pending insurance claims. What is the best way to file so that timely follow-up can be made?

Documentation from private insurance carriers sent to participating providers that accompanies payment and describes the response to a claim is referred to by the acronym ____________________.

If an insurance company admits that a patient signed an assignment of benefits document and that it inadvertently paid the patient instead of the physician, the insurance company should

An insurance claims register provides a

Which of the following is a benefit to using the online health insurance provider web portal?

A peer review is usually done before the appeal process.

The insurance industry is protected by a special exemption from the Federal Trade Commission (FTC).

An insurance claim with an invalid procedure code would be

The correct method to send documents for a Medicare reconsideration (Level 2) is by

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