Insurance Billing Test

Question 1

Coordination of Benefits

Answer 1

determination of which policy is primary and which policy is secondary when a patient is covered by two policies

Question 2

EDI

Answer 2

another name for an electronic transmission

Question 3

ABN

Answer 3

advance beneficiary notice - a patient may be recommended for a service that may be denied by Medicare for which the patient would be responsible for paying

Question 4

Out of Pocket Expense

Answer 4

anything that patient has to pay such as deductibles, copayments, coinsurance, and noncovered services

Question 5

Physician Fee Schedule

Answer 5

a list of the amount charged for each procedure/service

Question 6

Verification of Insurance/Benefits

Answer 6

is done before the patient comes into the office. It is a determination of whether the patient is eligible for coverage of service

Question 7

CMA

Answer 7

currently administer the medicare program

Question 8

Medicare Part A

Answer 8

covers hospital visits

Question 9

Medicare Part B

Answer 9

covers physician services

Question 10

Medicare Part C

Answer 10

is a managed care option

Question 11

Medicare Part D

Answer 11

covered medication

Question 12

Workman Compensation w/c

Answer 12

is coverage for those injured on the job

Question 13

Tricare

Answer 13

is coverage for dependents of current and retired military personnel

Question 14

Primary Payer

Answer 14

the insurance that is billed first and expected to pay first and higher portion of the charges

Question 15

Secondary Payer

Answer 15

the insurance that is billed second and expected to pay second and lower portion of charges

Question 16

Medicare

Answer 16

insurance coverage primarily for those over age 65

Question 17

Medicaid

Answer 17

insurance coverage primarily for those with low income

Question 18

CMS-1500

Answer 18

a uniform billing format for medical claims

Question 19

Preauthorization

Answer 19

obtaining permission for coverage from the patient insurance carrier prior to service being provided

Question 20

Deductible

Answer 20

an amount of money that the insured must pay before the insurance beings to pay

Question 21

NPI

Answer 21

an unique 10-digit-number assigned to a provider

Question 22

Copayment

Answer 22

a fixed payment made at the time of services as determined by the insurance carrier

Question 23

Primary Care Provider

Answer 23

belongs to a network of providers and arranges for specialist for the patient

Question 24

Can providers charge a different amount to each insurance company for the same service?

Answer 24

No

Question 25

What is vital for reimbursement and the insurance company is contacted to get preauthorization?

Answer 25

Accuracy in obtaining patient information