Test bankFor
Understanding Health Insurance AGuide to Billing and Reimbursement, 21st Edition by Michelle A. Green Chapter 1-17 Capter 1 1. 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. ANSWER: c 2. 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 ANSWER: b 3. 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. ANSWER: c 4. Which is another name for a health insurance specialist? a. billing specialist b. coding specialist c. health information specialist d. reimbursement specialist ANSWER: d 5. 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. ANSWER: d 6. 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