Question 1

Match each term with its definition.
-The most common of these are federal and state agencies,insurance companies,and workers' compensation

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 insuranceR) D) and F)
S) F) and I)

Question 2

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once.
-​Claims can be entered from anywhere with Internet access with real-time response

Accepted Answer

A)  ​manual claims tracking
B)  ​electronic claims trackingC) A) and B)
D) undefined

Question 3

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 todayE) B) and C)
F) A) and D)

Question 4

Match each type of information found on an Explanation of Benefits (EOB) form with its definition.
-Amount of money that a patient's insurance company did not pay the 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 amountI) B) and H)
J) E) and F)

Question 5

Match each term with its definition.
-Authorizes benefits to be paid directly from a third-party payer to a provider

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 insuranceR) G) and I)
S) B) and O)

Question 6

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

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 insuranceR) C) and I)
S) E) and K)

Question 7

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-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 insuranceR) J) and L)
S) F) and J)

Question 8

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once.
-​Payers typically do not inform providers of the status of their claims

Accepted Answer

A)  ​manual claims tracking
B)  ​electronic claims trackingC) A) and B)
D) undefined

Question 9

​Which of the following is not one of the necessary pieces of information to have before calling to follow up on a delinquent insurance claim?

Accepted Answer

A)   ​the amount of copay received from the patient
B)   ​your practice's tax identification number
C)   ​the patient's name,identification number,and group name or number
D)   ​if the patient is not the insured,the insured's (e.g. ,spouse's) nameE) A) and C)
F) A) and B)

Question 10

​Which of the following is not considered a true statement regarding the history of claims?

Accepted Answer

A)   ​Third-party claims developed to indicate payment of services rendered by someone other than the patient.
B)   ​Providers have never been paid using an exchange of services or bartering of goods.
C)   ​Since 2005 providers have been urged to send claims electronically.
D)   ​All of the aboveE) C) and D)
F) B) and D)

Question 11

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

Accepted Answer

A)   18
B)   10
C)   9
D)   5E) None of the above
F) A) and C)

Question 12

​Ambulatory payment classifications (APCs) are:

Accepted Answer

A)   ​the government's method of paying for facility outpatient services for Medicare
B)   ​when physicians are reimbursed via other methodologies,such as CPT
C)   ​is the unit of payment under the outpatient prospective payment system (OPPS) 
D)   ​all of the aboveE) A) and D)
F) B) and C)

Question 13

The CMS-1500 form is accepted by:

Accepted Answer

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

Question 14

​_____________________ means that the doctor,provider,or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services.

Accepted Answer

A)   ​Adjudication
B)   ​Scrubbing
C)   ​Ambulatory payment classification
D)   ​AssignmentE) B) and C)
F) A) and B)

Question 15

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once.
-​A time-consuming process that frequently causes payment delays

Accepted Answer

A)  ​manual claims tracking
B)  ​electronic claims trackingC) A) and B)
D) undefined

Question 16

​Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once.
-​When providers seek Medicare payment they do not deserve but have not knowingly or intentionally done so

Accepted Answer

A)  ​fraud
B)  ​abuseC) A) and B)
D) undefined

Question 17

​Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once.
-​With intent

Accepted Answer

A)  ​fraud
B)  ​abuseC) A) and B)
D) undefined

Question 18

Since 2005,providers have been urged to:

Accepted Answer

A)   require patients to pay the full balance before leaving the office
B)   bill patients directly,requiring them to seek reimbursement on their own
C)   send claims manually
D)   send claims electronicallyE) None of the above
F) B) and C)

Question 19

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once.
-​Payment is quicker,claims usually received by a payer within 24 hours

Accepted Answer

A)  ​manual claims tracking
B)  ​electronic claims trackingC) A) and B)
D) undefined

Question 20

​Match the type of insurance to its description.Note: Answers may be used more than once.
-​All of the providers in the network are required to file a claim to get paid

Accepted Answer

A)  ​IPA
B)  ​HMO
C)  ​PPOD) All of the above
E) B) and C)

Exam 31: Preparing Insurance Claims and Posting Insurance Payments

Match each term with its definition. -The most common of these are federal and state agencies,insurance companies,and workers' compensation

Correct AnswerverifiedShow Answer

​Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once. -​When providers seek Medicare payment they do not deserve but have not knowingly or intentionally done so

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

​Which of the following is not one of the necessary pieces of information to have before calling to follow up on a delinquent insurance claim?

Correct AnswerverifiedShow Answer

​Ambulatory payment classifications (APCs) are:

Correct AnswerverifiedShow Answer

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -​Payers typically do not inform providers of the status of their claims

Correct AnswerverifiedShow Answer

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -​A time-consuming process that frequently causes payment delays

Correct AnswerverifiedShow Answer

Match each type of information found on an Explanation of Benefits (EOB) form with its definition. -Amount of money that a patient's insurance company did not pay the provider

Correct AnswerverifiedShow Answer

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -​Claims can be entered from anywhere with Internet access with real-time response

Correct AnswerverifiedShow Answer

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -​Payment is quicker,claims usually received by a payer within 24 hours

Correct AnswerverifiedShow Answer

​Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once. -​With intent

Correct AnswerverifiedShow Answer

​Which of the following is not considered a true statement regarding the history of claims?

Correct AnswerverifiedShow Answer

Match each term with its definition. -Authorizes benefits to be paid directly from a third-party payer to a provider

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

Manual claims tracking:

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

The CMS-1500 form is accepted by:

Correct AnswerverifiedShow Answer

​Match the type of insurance to its description.Note: Answers may be used more than once. -​All of the providers in the network are required to file a claim to get paid

Correct AnswerverifiedShow Answer

​_____________________ means that the doctor,provider,or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services.

Correct AnswerverifiedShow Answer

Since 2005,providers have been urged to:

Correct AnswerverifiedShow Answer

Correct Answer
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Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once. -When providers seek Medicare payment they do not deserve but have not knowingly or intentionally done so

Correct Answer
verified

Correct Answer
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Which of the following is not one of the necessary pieces of information to have before calling to follow up on a delinquent insurance claim?

Correct Answer
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Ambulatory payment classifications (APCs) are:

Correct Answer
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Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -Payers typically do not inform providers of the status of their claims

Correct Answer
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Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -A time-consuming process that frequently causes payment delays

Correct Answer
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Correct Answer
verified

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -Claims can be entered from anywhere with Internet access with real-time response

Correct Answer
verified

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -Payment is quicker,claims usually received by a payer within 24 hours

Correct Answer
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Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once. -With intent

Correct Answer
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Which of the following is not considered a true statement regarding the history of claims?

Correct Answer
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Correct Answer
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Correct Answer
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Correct Answer
verified

Correct Answer
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Correct Answer
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Match the type of insurance to its description.Note: Answers may be used more than once. -All of the providers in the network are required to file a claim to get paid

Correct Answer
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_____________________ means that the doctor,provider,or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services.

Correct Answer
verified

Correct Answer
verified