Deck 1: Health Insurance Specialist Career

Question 1

Which guarantees repayment for financial losses resulting from an employee's act or failure to act?

A) bonding insurance
B) liability insurance
C) property insurance
D) workers' compensation insurance

Answer 1

bonding insurance

Question 2

Which type of insurance covers employees and their dependents against injury and death that occurs during the course of employment?

A) bonding
B) liability
C) property
D) workers' compensation

Answer 2

workers' compensation

Question 3

Which term describes the principles of right or good conduct and includes rules that govern the conduct of members of a profession?

A) biased
B) ethics
C) immoral
D) misleading

Answer 3

ethics

Question 4

Which is another name for a health insurance specialist?

A) billing specialist
B) coding specialist
C) health information specialist
D) reimbursement specialist

Question 5

Which is submitted to the payer requesting reimbursement?

A) explanation of benefits
B) health insurance claim
C) remittance advice
D) preauthorization form

Question 6

When a health insurance plan's preauthorization requirements are not met by providers,

A) administrative costs are reduced.
B) patients' coverage is canceled.
C) payment of the claim is denied.
D) providers pay a fine to the plan.

Question 7

If the insurance plan has a hold harmless clause, it means that the patient is

A) charged for fees by the health care provider, per the EOB.
B) automatically has lower out-of-pocket health care expenses.
C) not responsible for paying what the insurance plan denies.
D) required to pay any amounts that the insurance plan denies.

Question 8

Which coding system is used to report procedures and services on claims?

A) CPT
B) ICD-10-CM
C) SNDO
D) SNOMED

Question 9

Health information technicians _____.

A) assist with direct patient care
B) document clinical information
C) manage medical records
D) process health insurance claims

Question 10

The Centers for Medicare and Medicaid Services (CMS) agency is located in the __________.

A) ACF
B) DHHS
C) FDA
D) OIG

Question 11

The word embezzle means to _____.

A) compensate
B) disburse
C) remunerate
D) steal

Question 12

Medical malpractice insurance is which type of insurance?

A) bonding
B) liability
C) property
D) workers' compensation

Question 13

Which would be found on a remittance advice?

A) detected errors and omissions from claims
B) documentation of medical necessity
C) payment information about a claim
D) provider qualifications and responsibilities

Question 14

A claims examiner is employed by a

A) facility to submit claims.
B) governmental agency to process claims.
C) physician's office to submit claims.
D) third-party payer to review claims.

Question 15

Which involves linking every procedure or service code reported on the claim to a condition code that justifies the necessity of performing that procedure or service?

A) claims adjudication
B) diagnosis coding
C) medical necessity
D) reimbursement processing

Question 16

Independent contractors should purchase __________ liability insurance, which provides protection from claims that contain errors and omissions resulting from professional services provided to clients as expected of a person in the contractor's profession.

A) bonding
B) business
C) professional
D) property

Question 17

The process of reporting __________ as numeric and alphanumeric characters on the insurance claim is called coding.

A) dates of service for procedures
B) diagnoses and procedures/services
C) health insurance claims identifiers
D) national provider identifiers

Question 18

The CPT manual is published by the

A) American Billing Association.
B) American Board of Physicians.
C) American Dental Association.
D) American Medical Association.

Question 19

The Healthcare Common Procedure Coding System (HCPCS) consists of __________ codes.

A) CPT and national
B) DSM and CDT
C) ICD-10-CM and ICD-10-PCS
D) SNOMED and SNDO

Question 20

A claims examiner employed by a third-party payer reviews health-related claims to determine whether the charges are reasonable, in addition to

A) assigning ICD-10-CM and CPT codes.
B) billing patients for copayments and coinsurance.
C) determining medical necessity of services/procedures.
D) resubmitting denied claims to health care providers.

Question 21

Which coding system is used to report procedures and services on inpatient hospital claims?

A) CPT
B) HCPCS level II
C) ICD-10-CM
D) ICD-10-PCS

Question 22

Which organization offers the CMBS exam?

A) AAPC
B) AHIMA
C) AMBA
D) MAB

Question 23

During completion of a student internship, the facility will likely require students to sign a nondisclosure agreement to protect __________.

A) facility resources
B) health care finances
C) patient confidentiality
D) quality of patient care

Question 24

Which are published by CMS and used to report procedures, services, and supplies not classified in CPT?

A) dental codes
B) disease codes
C) injury codes
D) national codes

Question 25

Which is an insurance agreement that protects business contents against fire, theft, and other risks?

A) bonding insurance
B) business liability insurance
C) errors and omissions insurance
D) property insurance

Question 26

Which defines a profession, delineates qualifications and responsibilities, and clarifies supervision requirements?

A) job description
B) policy and procedure
C) scope of practice
D) workforce development

Question 27

Conduct or qualities that characterize a professional person are called __________.

A) certification
B) credentials
C) professionalism
D) specialization

Question 28

Which does a provider usually employ to perform administrative and clinical tasks, which help keep the office or clinic running smoothly?

A) health information technician
B) medical assistant
C) nurse practitioner
D) reimbursement specialist

Question 29

Which is Latin for "let the master answer," which means that the employer is liable for the actions and omissions of employees as performed and committed within the scope of their employment?

A) res gestae
B) res ipsa loquitur
C) respondeat superior
D) requiescat in pace

Question 30

The organization that hires a(n) __________ is not liable for the acts or omissions of that individual.

A) health insurance specialist
B) health care provider
C) independent contractor
D) medical assistant