FREE MEDICAL AND STUDY GAMES ABOUT BILLING AND

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FREE MEDICAL AND STUDY GAMES ABOUT BILLING AND

CODING EXAM QUESTIONS

Actual Qs and Ans Expert-Verified Explanation

This Exam contains:

-Guarantee passing score -38 Questions and Answers -format set of multiple-choice -Expert-Verified Explanation

Question 1: Participating Provider (PAR)

Answer:

A provider who agrees to provide medical services to a payer's policyholders according to the terms of the plan's contract.

Question 2: Coordination of Benefits (COB)

Answer:

A clause in an insurance policy that explains how the policy will pay if more than one insurance policy applies to the claim.

Question 3: HIPAA Referral Certification and Authorization

Answer:

The HIPAA X12N 278 transaction in which a provider asks a health plan for approval of a service and the health plan responds, providing a certification number for an approved request.

Question 4: Insured/Subscriber

Answer:

The policyholder of a health plan or medical insurance policy; also known as guarantor.

Question 5: Electronic Eligibility Verification

Answer:

Required payer response to the HIPAA standard transaction.

Question 6: Birthday rule

Answer:

The guideline that determines which of two parents with medical coverage has the primary insurance for a child; the parent whose day of birth is earlier in the calendar year is considered primary.

Question 7: Established Patient (EP)

Answer:

Patient who has received professional services from a provider (or another provider with the same specialty in the same practice) within the past three years.

Question 8: Referring Physician

Answer:

The physician who refers the patient to another physician for treatment.

Question 9: Accept Assignment

Answer:

A participating physician's agreement to accept the allowed charge as payment in full.

Question 10: Gender Rule

Answer:

Coordination of benefits rule for a child insured under both parents' plans under which the father's insurance is primary.

Question 11: Acknowledgment of Receipt of Notices of Privacy Practices

Answer:

Form accompanying a covered entity's Notice of Privacy Practices; covered entities must make a good-faith effort to have patients sign the acknowledgment.

Question 12: Referral Number

Answer:

Authorization number given by a referring physician to the referred physician.

Question 13: Secondary Insurance (payer)

Answer:

The health plan that pays benefits after the primary plan pays when a patient is covered by more than one plan.

Question 14: Referral Waiver

Answer:

Document a patient is asked to sign guaranteeing payment when a required referral authorization is pending.

Question 15: Supplemental Insurance

Answer:

Health plan, such as Medigap, that provides benefits for services that are not normally covered by a primary plan.

Question 16: Prior Authorization Number

Answer:

Identifying code assigned by a government program or health insurance plan when preauthorization is required; also called the certification number.

Question 17: Direct Provider

Answer:

Clinician who treats the patient face-to-face, in contrast to an indirect provider such as a laboratory.

Question 18: New Patient (NP)

Answer:

A patient who has not received professional services from a provider (or another provider with the same specialty in the same practice) within the past three years.

Question 19: HIPAA Eligibility for a Health Plan

Answer:

The HIPAA X12N 270/217 transaction in which a provider asks a health plan for information on a patient's eligibility for benefits and receives an answer from the plan.

Question 20: Primary Insurance (payer)

Answer:

Health plan that pays benefits first when a patient is covered by more than one plan.

Question 21: Chart Number

Answer:

A unique number that identifies a patient.

Question 22: Portal

Answer:

Website that serves as an entry point to other websites

Question 23: Assignment of Benefits

Answer:

Authorization by a policyholder that allows a health plan to pay benefits directly to a provider.

Question 24: Patient Information Form

Answer:

Form that includes a patient's personal, employment, and insurance company data needed to complete a healthcare claim; also known as a registration form.

Question 25: Self-Pay Patient

Answer:

A patient who does not have insurance coverage.

Question 26: Indirect Provider

Answer:

Clinician who does not interact face-to-face with the patient, such as a laboratory.

Question 27: Certification Number

Answer:

Number returned electronically by a health plan approving a referral authorization request when preauthorization is required.