Download Understanding Health Insurance A Guide to Billing and Reimbursement 18th Edition test bank and more Exams Nursing in PDF only on Docsity!
1. If the insurance plan has a holdharmlessclause , it means that the patient
a. is charged for fees by the health care provider, per the EOB. b. automatically has lower out-of-pocket health care expenses.
c. is not responsible for paying what the insurance plan denies.
d. was required to pay any amounts that the insurance plan denies.
ANSWER: c
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims
processing and the parties involved.
DATECREATED: 11/1/2022 11:32 AM
DATEMODIFIED: 11/1/2022 11:32 AM
- The process of reporting as numeric and alphanumeric characters on the insurance claim is called coding. a. dates of service for procedures b. diagnoses and procedures/services c. health insurance claims identifiers d. national provider identifiers
ANSWER: b
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims
processing and the parties involved.
DATECREATED: 11/1/2022 11:32 AM
DATEMODIFIED: 11/1/2022 11:32 AM
- A claims examiner employed by a third-party payer reviews health-related claims to determine whether the charges are reasonable, in addition to a. assigning ICD-10-CM and CPT codes. b. billing patients for copayments and coinsurance. c. determining medical necessity of services/procedures. d. resubmitting denied claims to health care providers.
ANSWER: c
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims
processing and the parties involved. UHI_GREEN_24_1.3 - Identify career opportunities available for health insurance specialists.
DATECREATED: 11/1/2022 11:32 AM
DATEMODIFIED: 11/1/2022 11:32 AM
- Which is another name for a health insurance specialist? a. billing specialist b. coding specialist c. health information specialist d. reimbursement specialist
ANSWER: d
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_1.3 - Identify career opportunities available for health
insurance specialists.
DATECREATED: 11/1/2022 11:32 AM
DATEMODIFIED: 11/1/2022 11:32 AM
- A claims examiner is employed by a a. facility to submit claims. b. governmental agency to process claims. c. physician’s office to submit claims. d. third-party payer to review claims.
ANSWER: d
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_1.3 - Identify career opportunities available for health
insurance specialists.
DATECREATED: 11/1/2022 11:32 AM
DATEMODIFIED: 11/1/2022 11:32 AM
- Which involves linking every procedure or service code reported on the claim to a condition code that justifies the necessity of performing that procedure or service? a. claims adjudication b. diagnosis coding c. medical necessity d. reimbursement processing
ANSWER: c
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims
processing and the parties involved.
DATECREATED: 11/1/2022 11:32 AM
DATEMODIFIED: 11/1/2022 11:32 AM
a. administrative costs are reduced. b. patients’ coverage is canceled. c. payment of the claim is denied. d. providers pay a fine to the plan.
ANSWER: c
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims
processing and the parties involved.
DATECREATED: 11/1/2022 11:32 AM
DATEMODIFIED: 11/1/2022 11:32 AM
- Which coding system is used to report procedures and services on claims? a. CPT b. ICD-10-CM c. SNDO d. SNOMED
ANSWER: a
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims
processing and the parties involved.
DATECREATED: 11/1/2022 11:32 AM
DATEMODIFIED: 11/1/2022 11:32 AM
- Which would be found on a remittance advice? a. detected errors and omissions from claims b. documentation of medical necessity c. payment information about a claim d. provider qualifications and responsibilities
ANSWER: c
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_1.5 - Describe the job responsibilities of a health
insurance specialist.
DATECREATED: 11/1/2022 11:32 AM
DATEMODIFIED: 11/1/2022 11:32 AM
- Which guarantees repayment for financial losses resulting from an employee’s act or failure to act? a. bonding insurance
b. liability insurance c. property insurance d. workers’ compensation insurance
ANSWER: a
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_1.6 - Differentiate among types of insurance
purchased by contractors and employers.
DATECREATED: 11/1/2022 11:32 AM
DATEMODIFIED: 11/1/2022 11:32 AM
- Medical malpractice insurance is which type of insurance? a. bonding b. liability c. property d. workers’ compensation
ANSWER: b
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_1.6 - Differentiate among types of insurance
purchased by contractors and employers.
DATECREATED: 11/1/2022 11:32 AM
DATEMODIFIED: 11/1/2022 11:32 AM
- Which type of insurance covers employees and their dependents against injury and death that occurs during the course of employment? a. bonding b. liability c. property d. workers’ compensation
ANSWER: d
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_1.6 - Differentiate among types of insurance
purchased by contractors and employers.
DATECREATED: 11/1/2022 11:32 AM
DATEMODIFIED: 11/1/2022 11:32 AM
16. The word embezzle means to.
a. compensate
b. DSM and CDT c. ICD-10-CM and ICD-10-PCS d. SNOMED and SNDO
ANSWER: a
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims
processing and the parties involved.
DATECREATED: 11/1/2022 11:32 AM
DATEMODIFIED: 11/1/2022 11:32 AM
- Health information technicians. a. assist with direct patient care b. document clinical information c. manage medical records d. process health insurance claims
ANSWER: c
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_1.3 - Identify career opportunities available for health
insurance specialists.
DATECREATED: 11/1/2022 11:32 AM
DATEMODIFIED: 11/1/2022 11:32 AM
- The organization that hires a(n) is not liable for the acts or omissions of that individual. a. health insurance specialist b. health care provider c. independent contractor d. medical assistant
ANSWER: c
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_1.6 - Differentiate among types of insurance
purchased by contractors and employers.
DATECREATED: 11/1/2022 11:32 AM
DATEMODIFIED: 11/1/2022 11:32 AM
- During completion of a student internship, the facility will likely require students to sign a nondisclosure agreement to protect. a. facility resources
b. health care finances c. patient confidentiality d. quality of patient care
ANSWER: c
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_1.4 - List the education and training requirements of a
health insurance specialist.
DATECREATED: 11/1/2022 11:32 AM
DATEMODIFIED: 11/1/2022 11:32 AM
- Which coding system is used to report procedures and services on inpatient hospital claims? a. CPT b. HCPCS level II c. ICD-10-CM d. ICD-10-PCS
ANSWER: d
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims
processing and the parties involved.
DATECREATED: 11/1/2022 11:32 AM
DATEMODIFIED: 11/1/2022 11:32 AM
- Which does a provider usually employ to perform administrative and clinical tasks, which help keep the office or clinic running smoothly? a. health information technician b. medical assistant c. nurse practitioner d. reimbursement specialist
ANSWER: b
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_1.3 - Identify career opportunities available for health
insurance specialists.
DATECREATED: 11/1/2022 11:32 AM
DATEMODIFIED: 11/1/2022 11:32 AM
- Which organization offers the CPB exam? a. AAPC
c. errors and omissions insurance d. property insurance
ANSWER: d
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_1.6 - Differentiate among types of insurance
purchased by contractors and employers.
DATECREATED: 11/1/2022 11:32 AM
DATEMODIFIED: 11/1/2022 11:32 AM
- Which is Latin for “let the master answer,” which means that the employer is liable for the actions and omissions of employees as performed and committed within the scope of their employment?
a. resgestae
b. resipsaloquitur
c. respondeatsuperior
d. requiescatinpace
ANSWER: c
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_1.6 - Differentiate among types of insurance
purchased by contractors and employers.
DATECREATED: 11/1/2022 11:32 AM
DATEMODIFIED: 11/1/2022 11:32 AM
- Which defines a profession, delineates qualifications and responsibilities, and clarifies supervision requirements? a. job description b. policy and procedure c. scope of practice d. workforce development
ANSWER: c
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_1.5 - Describe the job responsibilities of a health
insurance specialist.
DATECREATED: 11/1/2022 11:32 AM
DATEMODIFIED: 11/1/2022 11:32 AM
1. Which may specifically result in the early detection of health problems, allowing less drastic and less
expensive treatment options? a. health care insurance b. medical necessity c. preventive examination d. third-party payment
ANSWER: c
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_2.2 - Summarize basic health insurance and
managed care concepts.
DATECREATED: 11/1/2022 11:33 AM
DATEMODIFIED: 11/1/2022 11:33 AM
- Which provides health insurance coverage? a. continuity of care b. health insurance exchange c. meaningful use d. third-party payer
ANSWER: d
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_2.2 - Summarize basic health insurance and
managed care concepts.
DATECREATED: 11/1/2022 11:33 AM
DATEMODIFIED: 11/1/2022 11:33 AM
- Which type of health insurance coverage is subsidized by employers and other organizations? a. group health insurance b. individual health insurance c. public health insurance d. universal health insurance
ANSWER: a
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_2.2 - Summarize basic health insurance and
managed care concepts.
DATECREATED: 11/1/2022 11:33 AM
DATEMODIFIED: 11/1/2022 11:33 AM
- Which type of health insurance coverage is purchased by families who do not have access to employer-subsidized
- Which act provided federal grants for modernizing hospitals that had become obsolete because of a lack of capital investment during the Great Depression and World War II (1929–1945)? a. Brady Act b. Gramm-Leach-Bliley Act c. Hill-Burton Act d. Taft-Hartley Act
ANSWER: c
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_2.3 - Identify major developments in U.S. health insurance.
DATECREATED: 11/1/2022 11:33 AM
DATEMODIFIED: 11/1/2022 11:33 AM
- Which is the amount for which the patient is financially responsible before an insurance policy provides payment? a. coinsurance b. copayment c. deductible d. exclusionary
ANSWER: c
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_2.2 - Summarize basic health insurance and
managed care concepts.
DATECREATED: 11/1/2022 11:33 AM
DATEMODIFIED: 11/1/2022 11:33 AM
- Title XIX of the Social Security Amendments of 1965 is a cost-sharing program between the federal and state governments to provide health care services to low-income Americans. It is a government plan known as . a. CHAMPVA b. Medicaid c. Medicare d. TRICARE
ANSWER: b
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_2.3 - Identify major developments in U.S. health insurance.
DATECREATED: 11/1/2022 11:33 AM
DATEMODIFIED: 11/1/2022 11:33 AM
- Prior to implementation of a prospective payment system for acute care hospital inpatient stays, reimbursement was
generated on a basis, which issued payment based on daily rates. a. capitated
b. perdiem
c. prospective
d. resgestae
ANSWER: b
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_2.3 - Identify major developments in U.S. health insurance.
DATECREATED: 11/1/2022 11:33 AM
DATEMODIFIED: 11/1/2022 11:33 AM
- Medicare requires providers to submit the claim for payment of outpatient and office services. a. CMS- 1450 b. CMS- 1500 c. UB- 02 d. UB- 04
ANSWER: b
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_2.3 - Identify major developments in U.S. health insurance.
DATECREATED: 11/1/2022 11:33 AM
DATEMODIFIED: 11/1/2022 11:33 AM
- Clinical Laboratory Improvement Act (CLIA) legislation established for all laboratory testing to ensure the accuracy, reliability, and timeliness of patient test results regardless of where the test was performed. a. advance directives b. case management c. plan administration d. quality standards
ANSWER: d
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_2.3 - Identify major developments in U.S. health insurance.
DATECREATED: 11/1/2022 11:33 AM
DATEMODIFIED: 11/12/2022 7:18 AM
- The Resource-Based Relative Value Scale (RBRVS) system reimburses physicians’ practice expenses using a . a. fee schedule
b. diagnosis-related groups c. outcomes and assessment information d. resource utilization groups
ANSWER: a
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_2.3 - Identify major developments in U.S. health insurance.
DATECREATED: 11/1/2022 11:33 AM
DATEMODIFIED: 11/1/2022 11:33 AM
- Which was created by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) to identify and recover improper Medicare payments paid to health care providers under fee-for-service Medicare plans? a. government health care program b. medical audit program c. quality assurance program d. recovery audit contractor program
ANSWER: d
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_2.3 - Identify major developments in U.S. health insurance.
DATECREATED: 11/1/2022 11:33 AM
DATEMODIFIED: 11/1/2022 11:33 AM
- The Medicare Contracting Reform (MCR) initiative was established to integrate the administration of Medicare Parts A and B fee-for-service benefits with new entities called. a. carriers b. fiscal intermediaries c. Medicare administrative contractors d. third-party payers
ANSWER: c
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_2.3 - Identify major developments in U.S. health insurance.
DATECREATED: 11/1/2022 11:33 AM
DATEMODIFIED: 11/1/2022 11:33 AM
- The American Recovery and Reinvestment Act of 2009 (ARRA) established electronic health record (EHR) during three stages to achieve the goal of improved patient care outcomes and delivery as well as data capture and sharing, advance clinical processes, and improved outcomes. a. acquisition of health information technology systems
b. health care reform initiatives c. meaningful use objectives and measures d. privacy and security requirements
ANSWER: c
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_2.3 - Identify major developments in U.S. health insurance.
DATECREATED: 11/1/2022 11:33 AM
DATEMODIFIED: 11/1/2022 11:33 AM
- The primary purpose of the patient record is to provide for of care, which involves documenting patient care services so that others who treat the patient have a source of information to assist with additional care and treatment. a. continuity b. provision c. quality d. reimbursement
ANSWER: a
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_2.7 - Describe health care documentation methods.
DATECREATED: 11/1/2022 11:33 AM
DATEMODIFIED: 11/1/2022 11:33 AM
- POR progress notes are documented for each problem assigned to the patient, using the SOAP format. When the patient states, “I have had a stuffy nose and sore throat for about one week,” the provider documents the statement in the portion of the progress note. a. Subjective b. Objective c. Assessment d. Plan
ANSWER: a
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_2.7 - Describe health care documentation methods.
DATECREATED: 11/1/2022 11:33 AM
DATEMODIFIED: 11/1/2022 11:33 AM
- Which is a systematic method of documentation that consists of four components: database, problem list, initial plan, and progress notes? a. electronic record
practice improvement, and meaningful use of certified EHR technology. b. conducts utilization and quality control review of health care furnished, or to be furnished, to Medicare beneficiaries in order to generate cost savings for health care provided. c. documents patient care services so that others who treat the patient have a source of information to assist with additional care and treatment. d. focuses on private health insurance reform to provide better coverage for individuals with pre-existing conditions, resulting in a nationwide health insurance exchange program
ANSWER: a
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_2.8 - Discuss the impact of the electronic health record
(EHR) on health care.
DATECREATED: 11/1/2022 11:33 AM
DATEMODIFIED: 11/1/2022 11:33 AM
- The Health Maintenance Organization (HMO) Assistance Act of 1973 authorized grants and loans to develop HMOs
f r
y e
fiedHMO as being certified to provide health care services to
enrollees. a. anyone with U.S. citizenship as b. commercial and government c. Medicare and Medicaid d. TRICARE and CHAMPVA
ANSWER: c
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_2.4 - Describe the history, role, and effects of managed
care in health care.
DATECREATED: 11/1/2022 11:33 AM
DATEMODIFIED: 11/1/2022 11:33 AM
- The Healthcare Effectiveness Data and Information Set (HEDIS) was developed by the and created standards to assess managed care systems in terms of membership, utilization of services, quality, access, health plan management and activities, and financial indicators. a. Centers for Medicare and Medicaid Services (CMS) b. Joint Commission c. National Committee for Quality Assurance (NCQA) d. Office of the Inspector General (OIG)
ANSWER: c
POINTS: 1
QUESTIONTYPE: Multiple Choice
HASVARIABLES: False
LEARNINGOBJECTIVES: UHI_GREEN_24_2.5 - Explain the characteristics of health insurance and
