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Grade 8 College Continuing Education

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College Medical Insurance and Billing Questions

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College Medical Insurance and Billing
Medicare part A is known as:
  1. Supplementary Medical Insurance
  2. Hospice Insurance
  3. Hospital coverage
  4. Outpatient coverage
College Medical Insurance and Billing
Medicare part B is known as:
  1. Outpatient coverage
  2. Hospice Insurance
  3. Hospital coverage
  4. Prescription drug coverage
College Medical Insurance and Billing
A public or private agency primarily engaged in providing pain relief, symptom management, and supportive services to terminally ill patients and their families in their own homes or in a homelike center.
  1. Formulary
  2. Respite Care
  3. Hospice
  4. Advance Beneficiary
College Medical Insurance and Billing
HIPAA has brought forth electronic formats for determination of eligibility for a health insurance plan.
  1. True
  2. False
College Medical Insurance and Billing
HIPAA requires that the NPI number be used to identify employers rather than inputting the actual name of the company when submitting claims.
  1. True
  2. False
College Medical Insurance and Billing
Most state collection laws allow telephone calls to the debtor between 8 AM and 9 PM.
  1. True
  2. False
College Medical Insurance and Billing
When a patient has declared bankruptcy, it is permissible to continue to send monthly statements for a balance due.
  1. True
  2. False
College Medical Insurance and Billing
If the provider has no contract with the insurance carrier, the provider is not obligated to the carrier’s deadline.
  1. True
  2. False
College Medical Insurance and Billing
A decision to appeal a claim should be based on whether there is sufficient data to back up the claim and if there is a large amount of money in question.
  1. True
  2. False
College Medical Insurance and Billing
In the Medicare reconsideration Level 2 process, the request must be within 9 months from the date of the original determination shown on the remittance advice.
  1. True
  2. False
College Medical Insurance and Billing
If the insurance carrier is a self-insured plan, a Medicaid or Medicare health maintenance organization, or an Employee Retirement Income Security Act (ERISA)-based plan, the insurance commissioner:
  1. is able to assist with carrier issues
  2. is able to assist on specific problem issues related to payment
  3. is not able to assist with carrier issues
  4. is able to give help on denied insurance claims
College Medical Insurance and Billing
A service offered by a nonprofit agency assisting people in paying off their debts is known as:
  1. debt solutions
  2. grand-in-aid under the Hill-Burton Act
  3. small claims court
  4. credit counseling
College Medical Insurance and Billing
Today, most claims are submitted by means of:
  1. US Postal Service
  2. fax transmission
  3. phone transmission
  4. EDI
College Medical Insurance and Billing
Encounter forms should be reviewed annually for changes that may have been made to:
  1. diagnosis codes
  2. procedure codes
  3. HCPCs codes
  4. all of the above
College Medical Insurance and Billing
Under HIPAA, data elements that are used uniformly to document why patients are seen (diagnosis) and what is done to them during their encounter (procedure) are known as:
  1. TCS standards
  2. National Standard Format (NSF)
  3. medical code sets
  4. information elements
College Medical Insurance and Billing
A written request made to an insurance company to locate the status of an insurance claim is often referred to as:
  1. tracer
  2. inquiry
  3. follow-up
  4. all of the above
College Medical Insurance and Billing
An overpayment is receipt of less than the contract rate from a managed care plan for a patient who has received medical services.
  1. True
  2. False
College Medical Insurance and Billing
A collection agency must follow all the laws stated in the Fair Debt Collection Practices Act.
  1. True
  2. False
College Medical Insurance and Billing
Claim that is submitted within the time limit and correctly completed.
  1. clean claim
  2. pending claim
  3. paper claim
  4. electronic claim
College Medical Insurance and Billing
The insurance billing specialist does not need to know how to complete a paper claim as most claims are submitted electronically.
  1. True
  2. False
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