Deck 31: Preparing Insurance Claims and Posting Insurance Payments

Question 1

Since 2005,providers have been urged to:

A) require patients to pay the full balance before leaving the office
B) bill patients directly,requiring them to seek reimbursement on their own
C) send claims manually
D) send claims electronically

Answer 1

send claims electronically

Question 2

Match each type of information found on an Explanation of Benefits (EOB)form with its definition.
Amount of money that a patient's insurance company did not pay the provider

A)patient
B)insured ID number
C)claim number
D)type of service
E)date of service
F)charge
G)not allowed amount
H)coinsurance co-payment amount

Answer 2

not allowed amount

Question 3

The CMS-1500 form is accepted by:

A) Medicare
B) Medicaid
C) both Medicare and Medicaid
D) neither Medicare nor Medicaid

Answer 3

both Medicare and Medicaid

Question 4

What is the first step in completing a claim form?

A) Check to see if the patient's signature is on file for release of information.
B) Write the provider's federal tax ID number in the appropriate space.
C) Correctly complete boxes 1-3 on the form.
D) Check for a photocopy of the patient's insurance card.

Question 5

Match each type of information found on an Explanation of Benefits (EOB)form with its definition.
Code and brief description of the health-related service a patient received from a provider

A)patient
B)insured ID number
C)claim number
D)type of service
E)date of service
F)charge
G)not allowed amount
H)coinsurance co-payment amount

Question 6

Match each type of information found on an Explanation of Benefits (EOB)form with its definition.
Number that identifies or refers to the claim that either the patient or the health provider submitted to the insurance company

A)patient
B)insured ID number
C)claim number
D)type of service
E)date of service
F)charge
G)not allowed amount
H)coinsurance co-payment amount

Question 7

When following up on a delinquent claim,if the carrier tells you that it is still in process,you should:

A) resubmit the claim by mail
B) resubmit the claim by fax
C) send the patient a statement
D) request an anticipated date of payment

Question 8

Match each type of information found on an Explanation of Benefits (EOB)form with its definition.
Number assigned to a patient by the insurance company,which should match the number on the patient's insurance card

A)patient
B)insured ID number
C)claim number
D)type of service
E)date of service
F)charge
G)not allowed amount
H)coinsurance co-payment amount

Question 9

Which of the following is not an advantage of using an Electronic Claims Tracking (ECT)system?

A) Claims can be tracked online.
B) All claims are guaranteed to be paid if the forms are filled out correctly.
C) Far fewer phone calls need to be made to track unpaid claims.
D) The use of 24-hour rolling claims problem alerts reduces lost time.

Question 10

Which form is also known as the UB-04 form?

A) CMS-1450
B) CMS-1500
C) Explanation of Benefits (EOB)form
D) FCC Form 159-C

Question 11

Which of the following is not a fee usually charged by a clearinghouse?

A) start-up fee
B) flat monthly fee
C) customer service fee
D) per-claim transaction fee

Question 12

Manual claims tracking:

A) frequently causes payment delays
B) requires minimal effort on the part of office staff
C) is both inexpensive and efficient
D) is commonly used in most practices today

Question 13

Match each type of information found on an Explanation of Benefits (EOB)form with its definition.
Amount a provider billed the patient's insurance company for a service

A)patient
B)insured ID number
C)claim number
D)type of service
E)date of service
F)charge
G)not allowed amount
H)coinsurance co-payment amount

Question 14

The phrase _____ was coined to indicate payment of services rendered by someone other than the patient.

A) health care provider
B) health maintenance organization
C) third-party reimbursement
D) two-party system

Question 15

How many digits are in a National Provider Identifier (NPI)number?

A) 18
B) 10
C) 9
D) 5

Question 16

Match each type of information found on an Explanation of Benefits (EOB)form with its definition.
Beginning and end dates of the health-related service a patient received from a provider

A)patient
B)insured ID number
C)claim number
D)type of service
E)date of service
F)charge
G)not allowed amount
H)coinsurance co-payment amount

Question 17

When applying an insurance adjustment to a patient's account,you are not typically required to post the:

A) name of the insurance company making the adjustment
B) name of the secondary insurance company that might be billed later
C) amount of the adjustment
D) date of the adjustment

Question 18

When a third-party payer identifies an error on the claim form,the claim is:

A) rejected with a request to resubmit the form with corrections
B) rejected and barred from resubmission
C) paid,with a penalty fee subtracted for the error
D) held indefinitely until the medical office calls to inquire about its status

Question 19

Electronically processing claim forms to insurance carriers:

A) lengthens the turnaround time
B) reduces the amount of preparation time for the claims processor
C) is discouraged because of the danger of violating HIPAA
D) is more expensive than traditional manual claims processing

Question 20

Match each type of information found on an Explanation of Benefits (EOB)form with its definition.
Amount of money a patient owes as a share of the bill

A)patient
B)insured ID number
C)claim number
D)type of service
E)date of service
F)charge
G)not allowed amount
H)coinsurance co-payment amount

Question 21

The steps to file a third-party claim and accurately complete the CMS-1500 form include:

A) ​check the appropriate box regarding patient's condition related to employment,auto accident,other accident,and claim codes
B) ​the insured's policy for FECA number
C) ​the patient's or authorized person's signature
D) ​all of the above

Question 22

Match each term with its definition.
Sets forth the very specific requirements a provider must meet in order to submit paper claim forms and receive CMS payment

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB)form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance

Question 23

Match each term with its definition.
Developed to report the health care provided to the source of payment when third-party reimbursement was created

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB)form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance

Question 24

Match each term with its definition.
Standard claim form used for billing in medical offices

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB)form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance

Question 25

​Information required to file a third-party claim on the CMS-1500 form includes all but:

A) access to a photocopy of the patient's insurance card
B) the co-pay receipt given to patient at time of visit
C) ​the insured's name,full address,and telephone number
D) ​the relationship to the insured

Question 26

Match each term with its definition.
Form or document that may be sent to the patient by their insurance company after they have had a health care service that was paid by the insurance company (may take up to several months to receive)

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB)form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance

Question 27

Match each term with its definition.
Paper claim form that may be submitted by an institutional provider that meets certain requirements

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB)form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance

Question 28

Match each term with its definition.
Use of these allows a medical facility or provider's office to submit transactions faster and be paid sooner

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB)form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance

Question 29

Match each type of information found on an Explanation of Benefits (EOB)form with its definition.
Name of the person who received the service

A)patient
B)insured ID number
C)claim number
D)type of service
E)date of service
F)charge
G)not allowed amount
H)coinsurance co-payment amount

Question 30

Match each term with its definition.
Patient's signature on a form that permits the release of his or her information,allowing the claim to be filed on his or her behalf

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB)form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance

Question 31

Match each term with its definition.
This amount is posted from the insurance payment or insurance adjustment

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB)form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance

Question 32

Match each term with its definition.
Similar to the EOB but is the document provided by the pater to the provider

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB)form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance

Question 33

Match each term with its definition.
Type of payment used for centuries in the past

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB)form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance

Question 34

Match each term with its definition.
Book in which a list of insurance claims is kept

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB)form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance

Question 35

Match each term with its definition.
In many instances,this will pay most,if not all,of the balance left over from the primary insurance to your physician and will leave little out-of-pocket expenses for the patient

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB)form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance

Question 36

Match each term with its definition.
Private or public company that often serves as the middleman between providers and billing groups,payers,and other health care partners for the transmission and translation of electronic claims information into the specific format required by payers

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB)form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance

Question 37

Match each term with its definition.
Authorizes benefits to be paid directly from a third-party payer to a provider

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB)form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance

Question 38

Match each term with its definition.
The most common of these are federal and state agencies,insurance companies,and workers' compensation

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB)form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance

Question 39

Match each term with its definition.
These give you immediate access to the status of a claim or group of claims

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB)form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance

Question 40

Match each term with its definition.
This must be completed before submitting electronic media claims to Medicare

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB)form
G)Standard Electronic Data Interchange (EDI)Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI)transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT)systems
P)credit column
Q)secondary insurance

Question 41

​Match the type of insurance to its description.Note: Answers may be used more than once.
​All of the providers in the network are required to file a claim to get paid

A)​IPA
B)​HMO
C)​PPO

Question 42

​The process of billing a secondary insurance company involves which of the following?

A) ​After payment is received from the primary insurance,you must create a new bill with the secondary insurance information,or perform the electronic task of submitting the claim to the secondary insurer.
B) ​Click the unprinted paper claims link.
C) ​Check the set to bill link.
D) ​Billing at the same time you bill the initial claim to the primary insurance.

Question 43

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once.
​Payment is quicker,claims usually received by a payer within 24 hours

A)​manual claims tracking
B)​electronic claims tracking

Question 44

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once.
​Claims can be entered from anywhere with Internet access with real-time response

A)​manual claims tracking
B)​electronic claims tracking

Question 45

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once.
​Office cost is reduced by eliminating the need for stamps,forms,and excess office staff labor

A)​manual claims tracking
B)​electronic claims tracking

Question 46

​Which of the following is not considered a true statement regarding the history of claims?

A) ​Third-party claims developed to indicate payment of services rendered by someone other than the patient.
B) ​Providers have never been paid using an exchange of services or bartering of goods.
C) ​Since 2005 providers have been urged to send claims electronically.
D) ​All of the above

Question 47

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once.
​A time-consuming process that frequently causes payment delays

A)​manual claims tracking
B)​electronic claims tracking

Question 48

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once.
​Have a "claim scrubber" program that will scrub the claim before it is sent to payers

A)​manual claims tracking
B)​electronic claims tracking

Question 49

​Match the type of insurance to its description.Note: Answers may be used more than once.
​A group insurance that entitles members to services provided by participating hospitals,clinics,and providers

A)​IPA
B)​HMO
C)​PPO

Question 50

​Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once.
​When a person or company knowingly deceives Medicare as an intentional act to receive inappropriate payment from the program

A)​fraud
B)​abuse

Question 51

​Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once.
​With intent

A)​fraud
B)​abuse

Question 52

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once.
​Payers typically do not inform providers of the status of their claims

A)​manual claims tracking
B)​electronic claims tracking

Question 53

​A private or public company that often serves as the middleman between providers and billing groups,payers,and other health care partners for the transmission and translation of electronic claims information into the specific format required by payers is known as:

A) ​UB-04
B) ​clearinghouse
C) ​CMS-1500
D) ​crossover claim

Question 54

​Which of the following is not a common claim error?

A) ​use of correct ICD codes or ICD codes that support the CPT codes
B) ​the patient's-not the policy holder's-Social Security number or identification number used as the insurance plan ID number
C) ​use of an incorrect national provider identifier (NPI)
D) ​the Coordination of Benefits section not completed

Question 55

​Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once.
​When providers seek Medicare payment they do not deserve but have not knowingly or intentionally done so

A)​fraud
B)​abuse

Question 56

​Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once.
​Without intent

A)​fraud
B)​abuse

Question 57

​Which of the following is not one of the necessary pieces of information to have before calling to follow up on a delinquent insurance claim?

A) ​the amount of copay received from the patient
B) ​your practice's tax identification number
C) ​the patient's name,identification number,and group name or number
D) ​if the patient is not the insured,the insured's (e.g. ,spouse's)name

Question 58

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once.
​Requires office collection staff to perform the extra task of making phone calls to key payers to determine whether claims are being processed

A)​manual claims tracking
B)​electronic claims tracking

Question 59

​Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once.
​Billing for services,supplies,or equipment that were not medically necessary or not provided

A)​fraud
B)​abuse

Question 60

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once.
​Results can be viewed easily on a computer screen and information printed as needed

A)​manual claims tracking
B)​electronic claims tracking

Question 61

​Match the type of insurance to its description.Note: Answers may be used more than once.
​A network of providers and hospitals that are joined together to contract with insurance companies,employers,or other organizations to provide health care to subscribers and their families for a discounted fee

A)​IPA
B)​HMO
C)​PPO

Question 62

​Match the type of insurance to its description.Note: Answers may be used more than once.
​A type of insurance in which contracted services are provided by providers who maintain their own offices

A)​IPA
B)​HMO
C)​PPO

Question 63

​Match the type of insurance to its description.Note: Answers may be used more than once.
​Patients are responsible for any part of the provider's fee that the insurance does not pay

A)​IPA
B)​HMO
C)​PPO

Question 64

​The primary insurance information will be placed in _______ of the CMS-1500 form for secondary billing.

A) ​Block 9
B) the ​[Reserved for NUCC use] block
C) ​the FECA number block
D) ​the resubmission code block

Question 65

When a patient's health insurance plan supports the ability to check electronically the amount of copayment a patient will be responsible for and the amount of payment the insurance company will make;this is known as:

A) ​real-time assessment
B) ​electronic eligibility
C) ​real-time adjudication
D) ​electronic funds transfer

Question 66

​Match the type of insurance to its description.Note: Answers may be used more than once.
​If the patient receives out-of-network services,he may have to pay the provider in full and then file a claim with the insurance to get reimbursed

A)​IPA
B)​HMO
C)​PPO

Question 67

​Information required to post on the patient account includes all of the following except:

A) ​the date the claim was submitted
B) ​the check number of the payment
C) ​the name of the insurance company sending the payment
D) ​the date of the insurance payment or adjustment

Question 68

​_____________________ means that the doctor,provider,or supplier agrees (or is required by law)to accept the Medicare-approved amount as full payment for covered services.

A) ​Adjudication
B) ​Scrubbing
C) ​Ambulatory payment classification
D) ​Assignment

Question 69

​Match the type of insurance to its description.Note: Answers may be used more than once.
​Patients do not have to file a claim,and the provider may not charge a patient directly or send a bill

A)​IPA
B)​HMO
C)​PPO

Question 70

​When claim form errors are identified by the third-party payers,the claim is then rejected.Which of the following is not considered an error?

A) ​the correct place of service code
B) ​the sex of the patient is missing
C) ​a patient's nickname is used instead of his or her legal name (i.e. ,Bob instead of Robert)
D) ​incorrect patient birth date

Question 71

​Match the type of insurance to its description.Note: Answers may be used more than once.
If a patient receives health care from a network provider,he or she would usually not need to file a claim

A)​IPA
B)​HMO
C)​PPO

Question 72

​Ambulatory payment classifications (APCs)are:

A) ​the government's method of paying for facility outpatient services for Medicare
B) ​when physicians are reimbursed via other methodologies,such as CPT
C) ​is the unit of payment under the outpatient prospective payment system (OPPS)
D) ​all of the above