Health Insurance Reimbursement –
Final Exam
T/F? The process for filing appeals is the same for all insurance carriers and should be
performed in writing. - ANS-False
The time limit within which a TRICARE outpatient claim must be filed is
Answers:
a. by the end of the year following the year in which a service is provided.
b. within 1 year from the date a service is provided.
c. within 6 months from the date a service is provided.
d. by the end of the year in which a service is provided. - ANS-within 1 year from the
date a service is provided.
T/F? Illegal coding practices are subject to penalties, fines, and/or imprisonment. - ANS-
True
T/F? Encrypted data often look like gibberish to unauthorized users. - ANS-True
What is the system called that TRICARE claims processors use to verify beneficiary
eligibility?
Answers:
a. TRI-CHECK
b. Eligibility report
c. DEERS
d. CHAMPUS - ANS-DEERS
T/F? The Stark Law is commonly referred to as the Anti-Kickback statute. - ANS-False
T/F? The American Medical Association (AMA) developed the standards for electronic
data exchange. - ANS-False
T/F? In a medical practice, front office duties have lost importance. - ANS-False
T/F? You should not give patients the option of whether they would like to pay now or
have a bill sent - ANS-True
A follow-up effort made to an insurance company to locate the status of an insurance
claim is called a/an
Answers:
a. inquiry.
, b. tracer.
c. inquiry and tracer.
d. rebill. - ANS-inquiry.
T/F? The definition of total disability varies from policy to policy because there is no
standard definition. - ANS-True
T/F? In a telephone collection call, the first 2 minutes will set the scene for your
relationship with the patient. - ANS-False
T/F? Workers' compensation programs are included under the definition of a "health
plan" under HIPAA and must comply with all HIPAA standards. - ANS-False
When collecting fees, your goal should always be to
Answers:
a. leave the impression that you are a nice person.
b. collect the full amount.
c. collect at least one half the fee.
d. collect as much as possible. - ANS-collect the full amount.
T/F? Medical requirements are the same for both the SSDI and SSI programs. - ANS-
True
T/F? In an industrial case, the physician's office may collect all amounts not covered by
the workers' compensation fee schedule. - ANS-False
America's oldest privately owned, prepaid medical group is the
Answers:
a. INA Healthplan, Inc.
b. Health Net HMO, Inc.
c. Ross-Loos Medical Group.
d. Kaiser Permanente Medical Care Program. - ANS-Ross-Loos Medical Group.
T/F? A claims assistance professional (CAP) acts as an informal representative of
patients and helps patients interpret insurance contracts. - ANS-False
T/F? Disability income insurance provides benefits for work-related disability. - ANS-
False
T/F? Under federal regulations, a list of the most common services the physician offers,
including procedure code numbers with a description of each service and its price, must
be posted in the office waiting room. - ANS-False
Requires businesses to explain all interest charges, late charges, collection fees,
finance charges up front, before the time of service.
Answers:
Final Exam
T/F? The process for filing appeals is the same for all insurance carriers and should be
performed in writing. - ANS-False
The time limit within which a TRICARE outpatient claim must be filed is
Answers:
a. by the end of the year following the year in which a service is provided.
b. within 1 year from the date a service is provided.
c. within 6 months from the date a service is provided.
d. by the end of the year in which a service is provided. - ANS-within 1 year from the
date a service is provided.
T/F? Illegal coding practices are subject to penalties, fines, and/or imprisonment. - ANS-
True
T/F? Encrypted data often look like gibberish to unauthorized users. - ANS-True
What is the system called that TRICARE claims processors use to verify beneficiary
eligibility?
Answers:
a. TRI-CHECK
b. Eligibility report
c. DEERS
d. CHAMPUS - ANS-DEERS
T/F? The Stark Law is commonly referred to as the Anti-Kickback statute. - ANS-False
T/F? The American Medical Association (AMA) developed the standards for electronic
data exchange. - ANS-False
T/F? In a medical practice, front office duties have lost importance. - ANS-False
T/F? You should not give patients the option of whether they would like to pay now or
have a bill sent - ANS-True
A follow-up effort made to an insurance company to locate the status of an insurance
claim is called a/an
Answers:
a. inquiry.
, b. tracer.
c. inquiry and tracer.
d. rebill. - ANS-inquiry.
T/F? The definition of total disability varies from policy to policy because there is no
standard definition. - ANS-True
T/F? In a telephone collection call, the first 2 minutes will set the scene for your
relationship with the patient. - ANS-False
T/F? Workers' compensation programs are included under the definition of a "health
plan" under HIPAA and must comply with all HIPAA standards. - ANS-False
When collecting fees, your goal should always be to
Answers:
a. leave the impression that you are a nice person.
b. collect the full amount.
c. collect at least one half the fee.
d. collect as much as possible. - ANS-collect the full amount.
T/F? Medical requirements are the same for both the SSDI and SSI programs. - ANS-
True
T/F? In an industrial case, the physician's office may collect all amounts not covered by
the workers' compensation fee schedule. - ANS-False
America's oldest privately owned, prepaid medical group is the
Answers:
a. INA Healthplan, Inc.
b. Health Net HMO, Inc.
c. Ross-Loos Medical Group.
d. Kaiser Permanente Medical Care Program. - ANS-Ross-Loos Medical Group.
T/F? A claims assistance professional (CAP) acts as an informal representative of
patients and helps patients interpret insurance contracts. - ANS-False
T/F? Disability income insurance provides benefits for work-related disability. - ANS-
False
T/F? Under federal regulations, a list of the most common services the physician offers,
including procedure code numbers with a description of each service and its price, must
be posted in the office waiting room. - ANS-False
Requires businesses to explain all interest charges, late charges, collection fees,
finance charges up front, before the time of service.
Answers:
