Question 1

Another name for an encounter form is a:

Accepted Answer

An encounter form is commonly referred to as both a superbill and a charge ticket.

Question 2

Charges and payments for one period are listed on a(n):

Accepted Answer

B

Question 3

A(n) ________ claim occurs when the primary insurance plan automatically sends the claim on to the secondary insurance plan.

Accepted Answer

A coordination of benefit claim occurs when the primary insurance plan forwards the claim to the secondary insurance plan, ensuring that benefits are coordinated between the two insurers.

Question 4

The insurance bill is called a(n):

Accepted Answer

The answer of The insurance bill is called a(n):
...

Question 5

Two different types of claims are used by both Medicare and other insurance plans, one for professional billing and one for:

Accepted Answer

Institutional billing is used for hospitals and other facilities, while professional billing is used for individual healthcare providers.

Question 6

The first step in preparing a claim is to assign procedure and diagnosis codes.

Accepted Answer

The first step in preparing a claim is to assign procedure and diagnosis codes because these codes are used to identify the services provided and the patient's condition.

Question 7

Which of the following is a document listing each charge, the amount paid by insurance, the amount written down by the provider, and the amount due from the patient?

Accepted Answer

An open item statement is a document that details each charge, the amount paid by insurance, the amount written down by the provider, and the amount due from the patient.

Question 8

Putting charges and payments into the patient accounting system is called charging.

Accepted Answer

The answer of Putting charges and payments into the patient...

Question 9

Which of the following is NOT one of the eight transactions mandated by HIPAA?

Accepted Answer

Quality care response is not one of the eight standard transactions mandated by HIPAA. The other options listed are part of the standard transactions.

Question 10

After all of the patient's insurance plans have responded with an EOB, any remaining amount owed is the responsibility of the:

Accepted Answer

The patient is responsible for any remaining balance after all insurance plans have paid their portions as indicated in the Explanation of Benefits (EOB).

Question 11

Standardized electronic data interchange formats were mandated by:

Accepted Answer

HIPAA (Health Insurance Portability and Accountability Act) mandated the use of standardized electronic data interchange formats to improve the efficiency and security of healthcare data exchange.

Question 12

Which of the following is the FIRST step in the accounting workflow?

Accepted Answer

The first step in the accounting workflow is verifying patient insurance eligibility with the health plan to ensure coverage and benefits before proceeding with treatment and billing.

Question 13

All eight of the electronic transactions mandated by HIPAA were developed by the American National Standards Institute (ANSI) Data Interchange Standards Association (DISA) Accredited Standards Committee (ASC) X12n.

Accepted Answer

The HIPAA electronic transactions were developed by different organizations, including ASC X12n for some, but not all were developed by ANSI DISA ASC X12n.

Question 14

Which of the following medical professionals would bill for their services by using the professional claim ANSI837-P or CMS-1500?

Accepted Answer

All the listed medical professionals, including chiropractors, therapists, physicians, and osteopaths, use the professional claim ANSI837-P or CMS-1500 to bill for their services.

Question 15

The acronym EMC stands for:

Accepted Answer

The answer of The acronym EMC stands for:
...

Question 16

Which of the following is a payment sent to the provider after a claim has been adjudicated?

Accepted Answer

Remittance is a payment sent to the provider after a claim has been adjudicated.

Question 17

All of the following transaction standards have been finalized EXCEPT:

Accepted Answer

The first report of injury for reporting worker's compensation incidents is not a transaction standard that has been finalized.

Question 18

Which of the following is a paper or electronic document that explains the amounts that were paid to the provider?

Accepted Answer

Remittance advice is a document sent by a payer to a provider, detailing the amounts paid for services rendered, including any adjustments or denials.

Question 19

A health insurance claim is an example of a(n):

Accepted Answer

A health insurance claim is considered a secondary record because it is derived from primary records like medical charts and patient files.

Question 20

Which of the following refer to records created by abstracting relevant details from the primary records?

Accepted Answer

Secondary records are created by extracting and summarizing information from primary records.

Quiz 10: Healthcare Transactions and Billing