Chapter 01: Health Insurance Specialist Career
Page 1 Understanding Health Insurance 2022 17th Edition Green Test Bank
- If the insurance plan has a hold harmless clause, it means that the patient
- automatically has lower out-of-pocket health care expenses.
- is not responsible for paying what the insurance plan denies.
- was required to pay any amounts that the insurance plan denies.
is charged for fees by the health care provider, per the EOB.
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIV UHI_GREEN_23_1.2 - Briefly summarize health insurance claims processing and the
ES: parties involved.
DATE CREATED: 10/3/2021 11:05 PM
DATE MODIFIED: 10/3/2021 11:05 PM
- The process of reporting as numeric and alphanumeric characters on the insurance claim is called coding.
- dates of service for procedures
- diagnoses and procedures/services
- health insurance claims identifiers
- national provider identifiers
ANSWER: b
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIV UHI_GREEN_23_1.2 - Briefly summarize health insurance claims processing and the
ES: parties involved.
DATE CREATED: 10/3/2021 11:05 PM
DATE MODIFIED: 10/3/2021 11:05 PM
- 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..
- billing patients for copayments and coinsurance.
- determining medical necessity of services/procedures.
- resubmitting denied claims to health care providers.
ANSWER: c
POINTS: 1
QUESTION TYPEMultiple Choice
:
HAS VARIABLES False
: 1 / 4
Chapter 01: Health Insurance Specialist Career
Page 2 Understanding Health Insurance 2022 17th Edition Green Test Bank
LEARNING OBJE UHI_GREEN_23_1.2 - Briefly summarize health insurance claims processing and the
CTIVES: parties involved.
UHI_GREEN_23_1.3 - Identify career opportunities available for health insurance specialists.
DATE CREATED: 10/3/2021 11:05 PM
DATE MODIFIED:10/3/2021 11:05 PM
- Which is another name for a health insurance specialist?
- billing specialist
- coding specialist
- health information specialist
- reimbursement specialist
ANSWER: d
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVE
S:
UHI_GREEN_23_1.3 - Identify career opportunities available for health insurance specialists.
DATE CREATED: 10/3/2021 11:05 PM
DATE MODIFIED: 10/3/2021 11:05 PM
- A claims examiner is employed by a
- governmental agency to process claims.
- physician’s office to submit claims.
- third-party payer to review claims.
a facility to submit claims..
ANSWER: d
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVE
S:
UHI_GREEN_23_1.3 - Identify career opportunities available for health insurance specialists.
DATE CREATED: 10/3/2021 11:05 PM
DATE MODIFIED: 10/3/2021 11:05 PM
- Which involves linking every procedure or service code reported on the claim to a condition code that justifies the
- claims adjudication
- diagnosis coding
- medical necessity
- reimbursement processing 2 / 4
necessity of performing that procedure or service?
Chapter 01: Health Insurance Specialist Career
Page 3 Understanding Health Insurance 2022 17th Edition Green Test Bank
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIV UHI_GREEN_23_1.2 - Briefly summarize health insurance claims processing and the
ES: parties involved.
DATE CREATED: 10/3/2021 11:05 PM
DATE MODIFIED: 10/3/2021 11:05 PM
- The CPT manual is published by the
- American Billing Association.
- American Board of Physicians.
- American Dental Association.
- American Medical Association.
ANSWER: d
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIV UHI_GREEN_23_1.2 - Briefly summarize health insurance claims processing and the
ES: parties involved.
DATE CREATED: 10/3/2021 11:05 PM
DATE MODIFIED: 10/3/2021 11:05 PM
- Which is submitted to the payer requesting reimbursement?
- explanation of benefits
- health insurance claim
- remittance advice
- prior approval form
ANSWER: b
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES:UHI_GREEN_23_1.5 - Describe the job responsibilities of a health insurance specialist.
DATE CREATED: 10/3/2021 11:05 PM
DATE MODIFIED: 10/3/2021 11:05 PM
- The Centers for Medicare and Medicaid Services (CMS) agency is located in the .
- ACF
- DHHS
- FDA
- OIG 3 / 4
Chapter 01: Health Insurance Specialist Career
Page 4 Understanding Health Insurance 2022 17th Edition Green Test Bank
ANSWER: b
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIV UHI_GREEN_23_1.2 - Briefly summarize health insurance claims processing and the
ES: parties involved.
DATE CREATED: 10/3/2021 11:05 PM
DATE MODIFIED: 10/3/2021 11:05 PM
- When a health insurance plan’s prior approval requirements are not met by providers,
- administrative costs are reduced.
- patients’ coverage is canceled.
- payment of the claim is denied.
- providers pay a fine to the plan.
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIV UHI_GREEN_23_1.2 - Briefly summarize health insurance claims processing and the
ES: parties involved.
DATE CREATED: 10/3/2021 11:05 PM
DATE MODIFIED: 10/3/2021 11:05 PM
- Which coding system is used to report procedures and services on claims?
- CPT
- ICD-10-CM
- SNDO
- SNOMED
ANSWER: a
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIV UHI_GREEN_23_1.2 - Briefly summarize health insurance claims processing and the
ES: parties involved.
DATE CREATED: 10/3/2021 11:05 PM
DATE MODIFIED: 10/3/2021 11:05 PM
- Which would be found on a remittance advice?
- documentation of medical necessity
- payment information about a claim
- provider qualifications and responsibilities
- / 4
a detected errors and omissions from claims .