Question 1

Claims are classified as to their status upon submission to an insurance carrier as clean, dirty, incomplete, rejected, or _______.

Accepted Answer

The question asks for the classification of claims upon submission to an insurance carrier, and the options provided all pertain to this stage of the claims process. Of the choices given, pending is the most appropriate option to complete the list of categories, as it refers to claims that are still being processed and have not yet been fully evaluated by the insurance carrier.

Question 2

An incentive to physicians to participate with Medicare is faster claims payment.

Accepted Answer

Providing faster claims payment is one strategy Medicare uses to incentivize physicians to participate in the program. Other incentives may include access to a larger patient pool and reduced administrative burdens.

Question 3

Medicare patients typically have secondary (supplemental) coverage with ______________________________.

Accepted Answer

Medi-Gap

Question 4

Families of active duty military are required to seek care at a military facility. In the event that a service cannot be provided there and the recipient must go to a private facility, a ______________________________ is required.

Accepted Answer

The answer of Families of active duty military are required...

Question 5

On the CMS 1500, there are six lines available for CPT/HCPCS codes and six lines for diagnosis codes.

Accepted Answer

On the CMS 1500 form, there are spaces provided for up to six CPT/HCPCS codes (in the 24D field), but for diagnosis codes, there is a section (21) that allows for up to twelve diagnosis codes to be listed, not just six.

Question 6

A medical condition under active treatment at the time application is made for an insurance policy which may not be a covered service under the insurance policy is called a ______________________________.

Accepted Answer

The answer of A medical condition under active treatment at...

Question 7

Match each item with the correct statement below.
-Assigned by the IRS to each physician for income tax purposes

Accepted Answer

The Employer Identification Number (EIN) is assigned by the IRS to each physician for income tax purposes, as it is used to identify a business entity for tax reporting.

Question 8

A copy of ____ must be sent with a secondary claim in order to process the claim.

Accepted Answer

Remittance Advice is required with a secondary claim because it provides details on the payment and denial from the primary insurance, which is necessary for the secondary payer to process the claim.

Question 9

____ is the specified dollar amount the patient must pay the provider for each visit.

Accepted Answer

Copayment is the specified dollar amount that the patient must pay the provider for each visit. Coinsurance is a percentage of the cost of a service that the patient must pay, and deductible is the amount the patient must pay before insurance begins to cover costs. Charge is a general term for the cost of a service, but it does not specify if it is the patient or the insurance paying for it.

Question 10

Match each item with the correct statement below.
-Also referred to as Tax ID Number

Accepted Answer

The answer of Match each item with the correct statement...

Question 11

______________________________ is a ruling in an insurance policy when a patient has two or more insurance polices where benefits combined will not exceed 100% of the covered benefit

Accepted Answer

The answer of ______________________________ is a ruling in an insurance...

Question 12

The total amount the patient must pay for covered services before insurance benefits are payable is called a ____________________.

Accepted Answer

The answer of The total amount the patient must pay...

Question 13

Advanced Beneficiary Notices are strictly for use with Medicare patients when a service may not be considered medically necessary.

Accepted Answer

Advanced Beneficiary Notices (ABNs) are not only for use when a service may not be considered medically necessary. They may also be used when a service is not covered by Medicare or when the provider believes Medicare may deny payment for the service. ABNs are used to inform the patient of their financial responsibility and give them the option to accept or decline the service.

Question 14

The ____ authorization allows the insurance company to pay the physician directly for services.

Accepted Answer

The Assignment of Benefits authorization allows the insurance company to pay the physician directly for services rendered to the patient. HIPAA is a federal law that protects the privacy of patients' health information. Release of equity refers to accessing the value of a property, while waiver of liability refers to a legal agreement where an individual agrees to give up their right to sue a company or individual.

Question 15

A ____ physician is a physician or non-physician who requests an item or service for a beneficiary such as a consultation, surgery, diagnostic testing, or durable medical equipment and whose name goes in block 17 of the claim form.

Accepted Answer

A referring physician is the physician who requests a service or item for a beneficiary and is responsible for initiating and coordinating the beneficiary's care with other providers. Their name goes in block 17 of the claim form, which is specifically for the referring provider. Consultation or treating physicians may also be involved in the beneficiary's care, but the referring physician is the one who initially requested the service or item. Covering physician refers to a physician who temporarily takes over the care of a patient from the patient's primary physician, usually due to absence or unavailability.

Question 16

Medicare Part A covers ambulatory encounters in physician offices, physical therapy, ambulance services, etc.

Accepted Answer

Medicare Part A does not cover ambulatory encounters in physician offices, physical therapy, ambulance services, etc. These services are covered under Medicare Part B. Medicare Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.

Question 17

A patient whose Medicare claim number ends with "A" will have the same social security number and claim number.

Accepted Answer

A Medicare claim number ending in "A" is typically assigned to the primary wage earner and is the same as the individual's social security number.

Question 18

Which of the following providers do not have to accept assignment from Medicare?

Accepted Answer

Physicians are not required to accept assignment from Medicare, meaning they can choose whether or not to accept Medicare's approved amount as full payment for services.

Question 19

Medicare is a secondary payer when the patient is also covered by a working spouse's insurance.

Accepted Answer

The answer of Medicare is a secondary payer when the...

Question 20

Match each item with the correct statement below.
-The 8-digit identifier number for Medicare claim forms with a 2-digit location identifier

Accepted Answer

The National Provider ID is an 8-digit identifier number for Medicare claim forms with a 2-digit location identifier.

Quiz 14: Billing and Collections