Insurance A Guide to Billing

Understanding Health Insurance A Guide to Billing and Reimbursement, 2023 Edi�on, 18e Michelle Green (Solu�ons Manual All Chapters, 100% Original Verified, A+ Grade) All Chapters/Supplement files download link at the end of this file. 1 / 4

Solution and Answer Guide: Michelle A. Green, Understanding Health Insurance: A Guide to Billing and Reimbursement: 2023, 18th Edition, 9780357764060; Chapter 1: Health Insurance Specialist Career

© 2024 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.1 Solution and Answer Guide

MICHELLE A. GREEN, UNDERSTANDING HEALTH INSURANCE: A GUIDE TO BILLING AND

REIMBURSEMENT: 2023, 18

TH

EDITION, 9780357764060; CHAPTER 1: HEALTH INSURANCE

SPECIALIST CAREER

TABLE OF CONTENTS

Review .................................................................................................................................. 1 1.1: Multiple Choice .................................................................................................................... 1 1.2: Professionalism .................................................................................................................. 9

REVIEW

1.1: MULTIPLE CHOICE

• The document submitted to the payer requesting reimbursement is called a(n)
• explanation of benefits (EOB).
• health insurance claim.
• remittance advice.
• prior approval form.

ANS: b

Analysis:

• Incorrect. The patient receives an explanation of benefits (EOB) from the third-

party payer, which is a report detailing the results of processing a claim. A health insurance claim is the documentation submitted to a third-party payer or government program requesting reimbursement for the health care services provided.

• Correct. A health insurance claim is the documentation submitted to a third-

party payer or government program requesting reimbursement for the health care services provided.

• Incorrect. The provider receives a remittance advice (or remit), a notice that is

sent by the insurance company that contains payment information about a claim. A health insurance claim is the documentation submitted to a third-party payer or government program requesting reimbursement for the health care services provided.

• Incorrect. Many health insurance plans and programs require prior approval for

treatment by specialists and documentation of post-treatment reports, and if the prior approval form is not submitted prior to treatment, payment of the claim is denied. A health insurance claim is the documentation submitted to a third-party payer or government program requesting reimbursement for the health care services provided.

• / 4

Solution and Answer Guide: Michelle A. Green, Understanding Health Insurance: A Guide to Billing and Reimbursement: 2023, 18th Edition, 9780357764060; Chapter 1: Health Insurance Specialist Career

© 2024 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.2

• The Centers for Medicare and Medicaid Services (CMS) is an administrative agency

within the

• Administration for Children and Families.
• Department of Health and Human Services.
• Food and Drug Administration.
• Office of the Inspector General.

ANS: b

Analysis:

• Incorrect. The Administration for Children and Families is an administrative

agency of the Department of Health and Human Services. The Centers for Medicare and Medicaid Services is an administrative agency of the Department of Health and Human Services.

• Correct. The Centers for Medicare and Medicaid Services is an administrative

agency of the Department of Health and Human Services.

• Incorrect. The Food and Drug Administration is an administrative agency of the

Department of Health and Human Services. The Centers for Medicare and Medicaid Services is an administrative agency of the Department of Health and Human Services.

• Incorrect. The Office of the Inspector General for the Department of Health and

Human Services reports to the Secretary of HHS and the United States Congress. The Centers for Medicare and Medicaid Services is an administrative agency of the Department of Health and Human Services.

• A health care practitioner is also called a health care
• dealer.
• provider.
• purveyor.
• supplier.

ANS: b

Analysis:

• Incorrect. A health care dealer is an entity that purchases goods for wholesale

or retail re-selling, such as durable medical equipment. A health care provider is a health care practitioner, such as a physician, physician’s assistance, or nurse practitioner.

• Correct. A health care provider is a health care practitioner, such as a physician,

physician’s assistance, or nurse practitioner.

• Incorrect. A health care purveyor refers to an entity that sells or deals in a

particular type of goods. A health care provider is a health care practitioner, such as a physician, physician’s assistance, or nurse practitioner.

• Incorrect. A health care supplier is a person or organization that sells or supplies

goods, such as durable medical equipment. A health care provider is a health care practitioner, such as a physician, physician’s assistance, or nurse practitioner.

• / 4

Solution and Answer Guide: Michelle A. Green, Understanding Health Insurance: A Guide to Billing and Reimbursement: 2023, 18th Edition, 9780357764060; Chapter 1: Health Insurance Specialist Career

© 2024 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.3

• Which is the most appropriate response to a patient who calls the office and asks to

speak with the physician?

• Politely state that the physician is busy and cannot be disturbed.
• Explain that the physician is unavailable and ask if the patient would like to

leave a message.

• Transfer the call to the exam room where the physician is located.
• Offer to schedule an appointment for the patient to be seen by the physician.

ANS: b

Analysis:

• Incorrect. Office personnel should not state that the physician is busy and

cannot be disturbed. Office personnel should simply state that the physician is not available and offer to take a message that will be passed along to the physician when available.

• Correct. Office personnel should simply state that the physician is not available

and offer to take a message that will be passed along to the physician when available.

• Incorrect. Unless the physician has specifically requested that a particular

patient’s call be forwarded to the exam room, the patient’s call should be addressed by office personnel. Office personnel should simply state that the physician is not available and offer to take a message that will be passed along to the physician when available.

• Incorrect. The patient may only wish to speak to the physician; however, in many

cases the patient’s issue may be addressed by the physician or other medical staff (e.g., nurse practitioner, physician assistant) without the need for a patient appointment. Office personnel should simply state that the physician is not available and offer to take a message that will be passed along to the physician when available.

• The process of assigning diagnoses, procedures, and services using numeric and

alphanumeric characters is called

• coding.
• data processing.
• programming.
• reimbursement.

ANS: a

Analysis:

• Correct. Coding involves the assignment of numeric or alphanumeric characters

to diagnoses and procedures.

• Incorrect. Data processing is the collection and manipulation of data to produce

meaningful information. Coding involves the assignment of numeric or alphanumeric characters to diagnoses and procedures.

• Incorrect. Programming is the process of creating executable computer software

programs that instruct the computer to perform specific tasks. Coding involves the assignment of numeric or alphanumeric characters to diagnoses and procedures.

• Incorrect. Reimbursement is the payment a provider receives for performing

procedures and providing services or supplies. Coding involves the assignment of numeric or alphanumeric characters to diagnoses and procedures.

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