Question 1

​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

Accepted Answer

PPO (Preferred Provider Organization) involves a network of providers and hospitals that contract with insurance companies, employers, or other organizations to provide health care at discounted fees.

Question 2

​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

Accepted Answer

IPA is a type of insurance in which contracted services are provided by providers who maintain their own offices.

Question 3

​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

Accepted Answer

PPO (Preferred Provider Organization) plans often require patients to pay the difference between the provider's fee and what the plan pays, especially if the provider is out-of-network.

Question 4

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

Accepted Answer

Block 9 of the CMS-1500 form is designated for the primary insurance information when secondary billing is being submitted. This allows for the identification of primary insurance coverage details necessary for processing a secondary claim.

Question 5

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:

Accepted Answer

Real-time adjudication refers to the process where healthcare providers can instantly process claims with health insurance companies to determine the amount of copayment a patient owes and the amount the insurance will pay. This system allows for immediate financial transactions and clarity regarding payments, differentiating it from electronic eligibility (which checks insurance coverage) or electronic funds transfer (which is a method of transferring money).

Question 6

​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

Accepted Answer

This description matches a Preferred Provider Organization (PPO) plan. In a PPO, patients have the flexibility to see providers outside of their network, but may have to pay upfront and seek reimbursement, unlike Health Maintenance Organizations (HMOs) or Independent Practice Associations (IPAs) where services are typically confined to a network and structured differently in terms of payment and reimbursement.

Question 7

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

Accepted Answer

The date the claim was submitted is not required to post on the patient account. Posting on the patient account typically involves recording payments or adjustments received, not the date the claim was submitted to the insurance.

Question 8

​_____________________ 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.

Accepted Answer

Assignment in the context of Medicare means that the healthcare provider agrees to accept the Medicare-approved amount as full payment for covered services. This agreement can be on a case-by-case basis or the provider can be a participating provider who always accepts Medicare-approved amounts for all Medicare patients.

Question 9

​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

Accepted Answer

HMO (Health Maintenance Organization) plans typically have arrangements where patients do not have to file a claim, and the provider directly bills the HMO. Patients usually don't receive a bill to pay directly for covered services.

Question 10

​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?

Accepted Answer

The correct place of service code is not considered an error; it is a necessary and accurate piece of information required on a claim form. Errors typically involve missing or incorrect information, such as a missing patient's sex, use of a nickname instead of a legal name, or an incorrect birth date.

Question 11

​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

Accepted Answer

The answer of ​Match the type of insurance to its...

Question 12

​Ambulatory payment classifications (APCs)are:

Accepted Answer

Ambulatory Payment Classifications (APCs) are the government's method of paying for facility outpatient services for Medicare, which is the unit of payment under the Outpatient Prospective Payment System (OPPS). While physicians may be reimbursed through other methodologies, such as CPT codes, APCs specifically relate to facility outpatient services under Medicare.

Quiz 31: Preparing Insurance Claims and Posting Insurance Payments

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

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

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

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

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:

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

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

_____________________ 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.

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

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?

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

Ambulatory payment classifications (APCs) are:

Quiz 31: Preparing Insurance Claims and Posting Insurance Payments

​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

​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

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

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:

​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

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

​_____________________ 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.

​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

​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?

​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

​Ambulatory payment classifications (APCs) are:

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

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

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

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

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

_____________________ 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.

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

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?

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

Ambulatory payment classifications (APCs) are: