Question 1

The source document for completing the actual insurance claim form is the

Accepted Answer

A)  medical record. 
B)  CMS-1500. 
C)  UB-04. 
D)  encounter form.

Question 2

The process of reviewing claims to determine payment is called

Accepted Answer

A)  adjudication. 
B)  confirmation. 
C)  code linkage. 
D)  fraud check.

Question 3

____________________ CPT codes are used to capture the face-to-face time spent between a patient and the care provider.

Accepted Answer

A)  Revenue 
B)  Diagnostic 
C)  Evaluation and management 
D)  Physical exam

Question 4

Groups of doctors and other healthcare providers and facilities who voluntarily form a partnership that results in high-quality, coordinated healthcare is known as a/an

Accepted Answer

A)  traditional insurance plan. 
B)  Managed care plan. 
C)  Fee-for-service plan. 
D)  Accountable Care Organization.

Question 5

Dr. Lewis's office collects patients' co-pays at the time of arrival; Dr. Mbadu's office collects the co-pay as the patient is leaving the visit. Is one method more advisable than the other? Explain your answer.

Accepted Answer

The answer of Dr. Lewis's office collects patients' co-pays at...

Question 6

What is the name of the document typically sent by insurance companies to a subscriber detailing the services and charges submitted for payment by the medical office, the allowed amount, the co-pay satisfied by the patient, any deductible due, the amount paid by the insurance company, and the amount owed by the subscriber?

Accepted Answer

The answer of What is the name of the document...

Question 7

Jeannie Lopez has never been seen in Greensburg Medical Center. The evaluation and management code assigned will be based on the fact that she is a/an ___________ patient.

Accepted Answer

The answer of Jeannie Lopez has never been seen in...

Question 8

An insurance company submits payment to a medical practice, along with a document that details the patients and accounts for which payment is made. This document is called the

Accepted Answer

A)  Superbill. 
B)  encounter form. 
C)  remittance advice. 
D)  subscriber benefits notice.

Question 9

Explain why the health record is the source document for coding diagnoses and procedures.

Accepted Answer

The answer of Explain why the health record is the...

Question 10

In the Superbill Summary, shown what were the charges for the 30-minute office visit?

Accepted Answer

The answer of In the Superbill Summary, shown what were...

Question 11

The amount charged for each service provided in a medical practice is known as a

Accepted Answer

A)  chargemaster. 
B)  fee schedule. 
C)  ledger. 
D)  day sheet.

Question 12

A formal, written document that describes how a physician's practice or hospital ensures that rules, regulations, and standards are being adhered to is known as what kind of plan?

Accepted Answer

The answer of A formal, written document that describes how...

Question 13

The charge for each service (by CPT code) provided in a medical practice is known as the fee ________________.

Accepted Answer

The answer of The charge for each service (by CPT...

Question 14

An electronic claims process is more efficient than a manual process. Why?

Accepted Answer

The answer of An electronic claims process is more efficient...

Question 15

In the Superbill Summary shown, what type of visit did this patient have?

Accepted Answer

The answer of In the Superbill Summary shown, what type...

Question 16

As a result of which piece of legislation are hospitals and providers reimbursed based on proof that they are rendering high-quality, coordinated care to their patients?

Accepted Answer

A)  Health Information Technology for Economic and Clinical Health Act (HITECH) 
B)  Health Insurance Portability and Accountability Act (HIPA
A)  
C)  Affordable Care Act (AC
A)  
D)  Amendment to the Social Security Act

Exam 6: Financial Management: Insurance and Billing Functions