Question 1

Match each type of information found on an Explanation of Benefits (EOB)form with its definition.
-Beginning and end dates of the health-related service a patient received from a provider

Accepted Answer

A)  patient
B)  insured ID number
C)  claim number
D)  type of service
E)  date of serviceF) chargeG) not allowed amountH) coinsurance co-payment amount E

Question 2

Match each term with its definition.
-Book in which a list of insurance claims is kept

Accepted Answer

A)  bartered goods
B)  claim form
C)  third-party reimbursers
D)  CMS-1500
E)  CMS-1450F) Explanation of Benefits (EO
B)  formG) Standard Electronic Data Interchange (EDI) Enrollment formH) Remittance Advice formI) manual insurance logJ) signature on fileK) assignment of benefits clauseL) Electronic Data Interchange (EDI) transactionsM) Administrative Simplification Compliance Act (ASC
A)  N) clearinghouseO) Electronic Claims Tracking (ECT) systemsP) credit columnQ) secondary insurance I

Question 3

​Match the type of insurance to its description.Note: Answers may be used more than once.
-​A network of providers and hospitals that are joined together to contract with insurance companies,employers,or other organizations to provide health care to subscribers and their families for a discounted fee

Accepted Answer

A)  ​IPA
B)  ​HMO
C)  ​PPO C

Question 4

​Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once.
-​Billing for services,supplies,or equipment that were not medically necessary or not provided

Accepted Answer

A)  ​fraud
B)  ​abuse

Question 5

Match each term with its definition.
-Use of these allows a medical facility or provider'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-1450F) Explanation of Benefits (EO
B)  formG) Standard Electronic Data Interchange (EDI) Enrollment formH) Remittance Advice formI) manual insurance logJ) signature on fileK) assignment of benefits clauseL) Electronic Data Interchange (EDI) transactionsM) Administrative Simplification Compliance Act (ASC
A)  N) clearinghouseO) Electronic Claims Tracking (ECT) systemsP) credit columnQ) secondary insurance

Question 6

​Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once.
-​Without intent

Accepted Answer

A)  ​fraud
B)  ​abuse

Question 7

The steps to file a third-party claim and accurately complete the CMS-1500 form include:

Accepted Answer

A)   ​check the appropriate box regarding patient's condition related to employment,auto accident,other accident,and claim codes
B)   ​the insured's policy for FECA number
C)   ​the patient's or authorized person's signature
D)   ​all of the above

Question 8

​Match the type of insurance to its description.Note: Answers may be used more than once.
-​A group insurance that entitles members to services provided by participating hospitals,clinics,and providers

Accepted Answer

A)  ​IPA
B)  ​HMO
C)  ​PPO

Question 9

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once.
-​Have a "claim scrubber" program that will scrub the claim before it is sent to payers

Accepted Answer

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

Question 10

​The process of billing a secondary insurance company involves which of the following?

Accepted Answer

A)   ​After payment is received from the primary insurance,you must create a new bill with the secondary insurance information,or perform the electronic task of submitting the claim to the secondary insurer.
B)   ​Click the unprinted paper claims link.
C)   ​Check the set to bill link.
D)   ​Billing at the same time you bill the initial claim to the primary insurance.

Question 11

​Match the type of insurance to its description.Note: Answers may be used more than once.
-If a patient receives health care from a network provider,he or she would usually not need to file a claim

Accepted Answer

A)  ​IPA
B)  ​HMO
C)  ​PPO

Question 12

​Match the type of insurance to its description.Note: Answers may be used more than once.
-​If the patient receives out-of-network services,he may have to pay the provider in full and then file a claim with the insurance to get reimbursed

Accepted Answer

A)  ​IPA
B)  ​HMO
C)  ​PPO

Question 13

Match each term with its definition.
-Sets forth the very specific requirements a provider must meet in order to submit paper claim forms and receive CMS payment

Accepted Answer

A)  bartered goods
B)  claim form
C)  third-party reimbursers
D)  CMS-1500
E)  CMS-1450F) Explanation of Benefits (EO
B)  formG) Standard Electronic Data Interchange (EDI) Enrollment formH) Remittance Advice formI) manual insurance logJ) signature on fileK) assignment of benefits clauseL) Electronic Data Interchange (EDI) transactionsM) Administrative Simplification Compliance Act (ASC
A)  N) clearinghouseO) Electronic Claims Tracking (ECT) systemsP) credit columnQ) secondary insurance

Question 14

​Match the type of insurance to its description.Note: Answers may be used more than once.
-​Patients do not have to file a claim,and the provider may not charge a patient directly or send a bill

Accepted Answer

A)  ​IPA
B)  ​HMO
C)  ​PPO

Question 15

Match each type of information found on an Explanation of Benefits (EOB)form with its definition.
-Code and brief description of the health-related service a patient received from a provider

Accepted Answer

A)  patient
B)  insured ID number
C)  claim number
D)  type of service
E)  date of serviceF) chargeG) not allowed amountH) coinsurance co-payment amount

Question 16

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

Question 17

​Information required to post on the patient account includes all of the following except:

Accepted Answer

A)   ​the date the claim was submitted
B)   ​the check number of the payment
C)   ​the name of the insurance company sending the payment
D)   ​the date of the insurance payment or adjustment

Question 18

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

Question 19

​A 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 is known as:

Accepted Answer

A)   ​UB-04
B)   ​clearinghouse
C)   ​CMS-1500
D)   ​crossover claim

Question 20

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-1450F) Explanation of Benefits (EO
B)  formG) Standard Electronic Data Interchange (EDI) Enrollment formH) Remittance Advice formI) manual insurance logJ) signature on fileK) assignment of benefits clauseL) Electronic Data Interchange (EDI) transactionsM) Administrative Simplification Compliance Act (ASC
A)  N) clearinghouseO) Electronic Claims Tracking (ECT) systemsP) credit columnQ) secondary insurance

Exam 31: Preparing Insurance Claims and Posting Insurance Payments

Match each type of information found on an Explanation of Benefits (EOB) form with its definition. -Beginning and end dates of the health-related service a patient received from a provider

Match each term with its definition. -Book in which a list of insurance claims is kept

Match the type of insurance to its description.Note: Answers may be used more than once. -A network of providers and hospitals that are joined together to contract with insurance companies,employers,or other organizations to provide health care to subscribers and their families for a discounted fee

Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once. -Billing for services,supplies,or equipment that were not medically necessary or not provided

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

Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once. -Without intent

The steps to file a third-party claim and accurately complete the CMS-1500 form include:

Match the type of insurance to its description.Note: Answers may be used more than once. -A group insurance that entitles members to services provided by participating hospitals,clinics,and providers

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -Have a "claim scrubber" program that will scrub the claim before it is sent to payers

The process of billing a secondary insurance company involves which of the following?

Match the type of insurance to its description.Note: Answers may be used more than once. -If a patient receives health care from a network provider,he or she would usually not need to file a claim

Match the type of insurance to its description.Note: Answers may be used more than once. -If the patient receives out-of-network services,he may have to pay the provider in full and then file a claim with the insurance to get reimbursed

Match each term with its definition. -Sets forth the very specific requirements a provider must meet in order to submit paper claim forms and receive CMS payment

Match the type of insurance to its description.Note: Answers may be used more than once. -Patients do not have to file a claim,and the provider may not charge a patient directly or send a bill

Match each type of information found on an Explanation of Benefits (EOB) form with its definition. -Code and brief description of the health-related service a patient received from a provider

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

Information required to post on the patient account includes all of the following except:

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

A 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 is known as:

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

Exam 31: Preparing Insurance Claims and Posting Insurance Payments

Match each type of information found on an Explanation of Benefits (EOB) form with its definition. -Beginning and end dates of the health-related service a patient received from a provider

Match each term with its definition. -Book in which a list of insurance claims is kept

​Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once. -​Billing for services,supplies,or equipment that were not medically necessary or not provided

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

​Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once. -​Without intent

The steps to file a third-party claim and accurately complete the CMS-1500 form include:

​Match the type of insurance to its description.Note: Answers may be used more than once. -​A group insurance that entitles members to services provided by participating hospitals,clinics,and providers

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -​Have a "claim scrubber" program that will scrub the claim before it is sent to payers

​The process of billing a secondary insurance company involves which of the following?

​Match the type of insurance to its description.Note: Answers may be used more than once. -If a patient receives health care from a network provider,he or she would usually not need to file a claim

​Match the type of insurance to its description.Note: Answers may be used more than once. -​If the patient receives out-of-network services,he may have to pay the provider in full and then file a claim with the insurance to get reimbursed

Match each term with its definition. -Sets forth the very specific requirements a provider must meet in order to submit paper claim forms and receive CMS payment

​Match the type of insurance to its description.Note: Answers may be used more than once. -​Patients do not have to file a claim,and the provider may not charge a patient directly or send a bill

Match each type of information found on an Explanation of Benefits (EOB) form with its definition. -Code and brief description of the health-related service a patient received from a provider

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

​Information required to post on the patient account includes all of the following except:

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

​A 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 is known as:

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

Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once. -Billing for services,supplies,or equipment that were not medically necessary or not provided

Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once. -Without intent

Match the type of insurance to its description.Note: Answers may be used more than once. -A group insurance that entitles members to services provided by participating hospitals,clinics,and providers

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -Have a "claim scrubber" program that will scrub the claim before it is sent to payers

The process of billing a secondary insurance company involves which of the following?

Match the type of insurance to its description.Note: Answers may be used more than once. -If a patient receives health care from a network provider,he or she would usually not need to file a claim

Match the type of insurance to its description.Note: Answers may be used more than once. -If the patient receives out-of-network services,he may have to pay the provider in full and then file a claim with the insurance to get reimbursed

Match the type of insurance to its description.Note: Answers may be used more than once. -Patients do not have to file a claim,and the provider may not charge a patient directly or send a bill

Information required to post on the patient account includes all of the following except:

A 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 is known as: