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Grade 8 College Continuing Education

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Medical Insurance and Billing Questions - All Grades

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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
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
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
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
College Medical Insurance and Billing
Claims for dates of service in two different years may be submitted on the same claim form.
  1. True
  2. False
College Medical Insurance and Billing
Use of the standardized CMS-1500 claim form has simplified porcessing of paper claims.
  1. True
  2. False
College Medical Insurance and Billing
Physicians who experience downtimes of Internet services which are out of their control for more than 2 days may submit claims to Medicare on paper.
  1. True
  2. False
College Medical Insurance and Billing
When submitting supplemental documentation for processing of a claim, the patient's name and date of service only need to be on the front of a two-sided document.
  1. True
  2. False
College Medical Insurance and Billing
Claim missing required information.
  1. clean claim
  2. incomplete claim
  3. dirty claim
  4. invalid claim
College Medical Insurance and Billing
The online error-edit process allows providers to:
  1. decrease labor costs by freeing of staff of other duties
  2. correct claim errors prior to transmission of the claim
  3. reduce postage fees and trips to the post office
  4. reduce storage of claims
College Medical Insurance and Billing
Medicare claim that contains information that is complete and necessary but is illogical or incorrect.
  1. dirty claim
  2. invalid claim
  3. electronic claim
  4. rejected claim
College Medical Insurance and Billing
Phrase used when a calim is held back from payment.
  1. incomplete claim
  2. deleted claim
  3. paper claim
  4. pending claim
College Medical Insurance and Billing
Proofreading claims prior to submission can prevent denials and delay of claim processing.
  1. True
  2. False
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