FREE MEDICAL AND STUDY GAMES ABOUT CH3MEDICAL

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FREE MEDICAL AND STUDY GAMES ABOUT CH3MEDICAL

INSURANCE EXAM QUESTIONS

Actual Qs and Ans Expert-Verified Explanation

This Exam contains:

-Guarantee passing score -61 Questions and Answers -format set of multiple-choice -Expert-Verified Explanation

Question 1: *Walkout Receipt

Answer:

Document given to a patient who makes a payment.Question 2: *Do you bill Supplemental Insurance Plans before or after you have received payment from the primary?

Answer:

Afterward

Question 3: *Direct Provider

Answer:

The provider who treats the patient

Question 4: *What are some MCO's appointment regulations?

Answer:

• Physician must see patient in a short period of time after patient calls for apt.

• Emergencies need to be handled in the office instead of the ED.

Question 5: *New Patient

Answer:

A patient who has not received professional services from a provider, or another provider in the same practice with the same specialty, in the past 3 years.

Question 6: Why is it important to be aware of a patients plan information?

Answer:

So that you know what co-payments, precertification, referral requirements, and non-covered services are in a plan.

Question 7: *T/F

If both Gary's parents have primary medical insurance, his father's dob is 02-13-69, and his mother's dob is 03-04-68, his mother's plan is Gary's primary insurance.

Answer:

False

Question 8: Participating Provider (PAR)

Answer:

An In-network physician contracted with an insurance company to provide lower rates for the patient.

Question 9: *T/F

Accepting assignment of benefits means that the physician bills the payer on behalf of the patient and receives payment directly.

Answer:

True

Question 10: What does the Collection of Time-of-Service payment entail?

Answer:

1.Co-payments 2.Non-covered or over-limit fees

• Charges of non-participating providers.

3.Charges for self-pay patients

Question 11: *Under HIPAA, what must be verified about a person who requests PHI?

Answer:

• both A and B

Question 12: *T/F

The HIPAA Eligibility for a Health Plan transaction may be used to determine a patient's insurance coverage.

Answer:

True

Question 13: *What does it mean to process a patient financial agreement?

Answer:

It means that patients are given copies of their financial agreement while the practice files the original in the health record.

Question 14: *T/F

The policyholder and the patient are always the same individual

Answer:

False

Question 15: *COB

Answer:

Coordination of Benefits

Question 16: Direct Provider

Answer:

physician who directly treats the patient must sign an acknowledgment.

Question 17: *What does it mean by Matching Patient Name?

Answer:

The patient's name on a claim should be exactly the same as it is on the insurance card.Question 18: *The Tertiary insurance pays:

Answer:

• After the first and second payers

Question 19: *A certification number for a procedure is the result of which transaction and process?

Answer:

• referral and authorization

Question 20: *MCO

Answer:

Managed Care Organization

Question 21: *Established Patient

Answer:

A patient who has received professional services from a provider, or another provider in the same practice with the same specialty, in the past 3 years.

Question 22: Do Indirect Providers have to secure additional acknowledgment?

Answer:

No, though they must have a privacy policy.

Question 23: *T/F

Patient's dates of birth should be recorded using all four digits of the year of birth

Answer:

True Question 24: *What are the 3 parts for Processing encounter for billing purposes

Answer:

• Info about patients and insurance is gathered/verified.

• Data about diagnoses/procedures are documented by the provider and used by the medical

insurance specialist to update patients account.

• Collection of time-of-service charges from patients.

Question 25: How does an insurance specialist determine what is primary insurance when there are 2 plans present?

Answer:

The plan that pays first.