TEST BANK
Understanding Health Insurance: A Guide to Billing and Reimbursement, 2024
Edition, 19th edition
by Michelle Green
SC
O
R
EG
U
ID
ES
, Table of Content
Chapter 1. Health Insurance Specialist Career
Chapter 2. Introduction to Health Insurance and Managed Care
Chapter 3. Introduction to Revenue Management
Chapter 4. Revenue Management: Insurance Claims, Denied Claims and Appeals, and Credit
and Collections
SC
Chapter 5. Legal Aspects of Health Insurance and Reimbursement
Chapter 6. ICD-10-CM Coding
Chapter 7. CPT Coding
O
Chapter 8. HCPCS Level II Coding
Chapter 9. CMS Reimbursement Methodologies
R
Chapter 10. Coding Compliance Programs, Clinical Documentation Improvement, and Coding
for Medical Necessity
EG
Chapter 11. CMS-1500 and UB-04 Claims
Chapter 12. Commercial Insurance
Chapter 13. BlueCross BlueShield
U
Chapter 14. Medicare
ID
Chapter 15. Medicaid
Chapter 16. TRICARE
ES
Chapter 17. Workers’ Compensation
,Name Clas Dat
: s: e:
Chapter 01: Health Insurance Specialist Career
1. If the insurance plan has a hold harmless clause, it means that the patient
a. is charged for fees by the health care provider, per the EOB.
b. automatically has lower out-of-pocket health care expenses.
c. is not responsible for paying what the insurance plan denies.
d. was required to pay any amounts that the insurance plan
SC
denies.
ANSWER: c
POINTS: 1
QUESTION TYPE Multiple Choice
:
HAS VARIABLES: False
O
LEARNING OBJE UHI_GREEN_24_1.2 - Briefly summarize health insurance claims
CTIVES: processing and the parties involved.
DATE CREATED: 12/11/2023 3:17 PM
R
DATE MODIFIED: 12/20/2023 5:49 AM
2. The process of reporting as numeric and alphanumeric characters on the insurance claim is called coding.
a. dates of service for procedures
EG
b. diagnoses and
procedures/services
c. health insurance claims identifiers
d. national provider identifiers
ANSWER: b
POINTS: 1
U
QUESTION TYPE Multiple Choice
:
HAS VARIABLES: False
ID
LEARNING OBJE UHI_GREEN_24_1.2 - Briefly summarize health insurance claims
CTIVES: processing and the parties involved.
DATE CREATED: 12/11/2023 3:17 PM
DATE MODIFIED: 12/11/2023 3:17 PM
ES
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 the medical necessity of
services/procedures.
d. resubmitting denied claims to health care providers.
ANSWER: c
POINTS: 1
QUESTION T Multiple Choice
YPE:
, Name Clas Dat
: s: e:
Chapter 01: Health Insurance Specialist Career
HAS VARIAB False
LES:
LEARNING O UHI_GREEN_24_1.2 - Briefly summarize health insurance claims
BJECTIVES: processing and the parties involved.
UHI_GREEN_24_1.3 - Identify career opportunities available for health
insurance specialists.
SC
DATE CREAT 12/11/2023 3:17 PM
ED:
DATE MODIFI 12/11/2023 3:30 PM
ED:
4. Which is another name for a health insurance specialist?
O
a. billing specialist
b. coding specialist
c. health information
R
specialist
d. reimbursement specialist
ANSWER: d
EG
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJEC UHI_GREEN_24_1.3 - Identify career opportunities available for
TIVES: health insurance specialists.
DATE CREATED: 12/11/2023 3:17 PM
U
DATE MODIFIED: 12/11/2023 3:17 PM
5. A claims examiner is employed by a
ID
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.
ES
ANSWER: d
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJEC UHI_GREEN_24_1.3 - Identify career opportunities available for
TIVES: health insurance specialists.
DATE CREATED: 12/11/2023 3:17 PM
DATE MODIFIED: 12/11/2023 3:17 PM
6. Which involves linking every procedure or service code reported on the claim to a condition code that justifies the
reason for performing that procedure or service?
a. claims adjudication
Understanding Health Insurance: A Guide to Billing and Reimbursement, 2024
Edition, 19th edition
by Michelle Green
SC
O
R
EG
U
ID
ES
, Table of Content
Chapter 1. Health Insurance Specialist Career
Chapter 2. Introduction to Health Insurance and Managed Care
Chapter 3. Introduction to Revenue Management
Chapter 4. Revenue Management: Insurance Claims, Denied Claims and Appeals, and Credit
and Collections
SC
Chapter 5. Legal Aspects of Health Insurance and Reimbursement
Chapter 6. ICD-10-CM Coding
Chapter 7. CPT Coding
O
Chapter 8. HCPCS Level II Coding
Chapter 9. CMS Reimbursement Methodologies
R
Chapter 10. Coding Compliance Programs, Clinical Documentation Improvement, and Coding
for Medical Necessity
EG
Chapter 11. CMS-1500 and UB-04 Claims
Chapter 12. Commercial Insurance
Chapter 13. BlueCross BlueShield
U
Chapter 14. Medicare
ID
Chapter 15. Medicaid
Chapter 16. TRICARE
ES
Chapter 17. Workers’ Compensation
,Name Clas Dat
: s: e:
Chapter 01: Health Insurance Specialist Career
1. If the insurance plan has a hold harmless clause, it means that the patient
a. is charged for fees by the health care provider, per the EOB.
b. automatically has lower out-of-pocket health care expenses.
c. is not responsible for paying what the insurance plan denies.
d. was required to pay any amounts that the insurance plan
SC
denies.
ANSWER: c
POINTS: 1
QUESTION TYPE Multiple Choice
:
HAS VARIABLES: False
O
LEARNING OBJE UHI_GREEN_24_1.2 - Briefly summarize health insurance claims
CTIVES: processing and the parties involved.
DATE CREATED: 12/11/2023 3:17 PM
R
DATE MODIFIED: 12/20/2023 5:49 AM
2. The process of reporting as numeric and alphanumeric characters on the insurance claim is called coding.
a. dates of service for procedures
EG
b. diagnoses and
procedures/services
c. health insurance claims identifiers
d. national provider identifiers
ANSWER: b
POINTS: 1
U
QUESTION TYPE Multiple Choice
:
HAS VARIABLES: False
ID
LEARNING OBJE UHI_GREEN_24_1.2 - Briefly summarize health insurance claims
CTIVES: processing and the parties involved.
DATE CREATED: 12/11/2023 3:17 PM
DATE MODIFIED: 12/11/2023 3:17 PM
ES
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 the medical necessity of
services/procedures.
d. resubmitting denied claims to health care providers.
ANSWER: c
POINTS: 1
QUESTION T Multiple Choice
YPE:
, Name Clas Dat
: s: e:
Chapter 01: Health Insurance Specialist Career
HAS VARIAB False
LES:
LEARNING O UHI_GREEN_24_1.2 - Briefly summarize health insurance claims
BJECTIVES: processing and the parties involved.
UHI_GREEN_24_1.3 - Identify career opportunities available for health
insurance specialists.
SC
DATE CREAT 12/11/2023 3:17 PM
ED:
DATE MODIFI 12/11/2023 3:30 PM
ED:
4. Which is another name for a health insurance specialist?
O
a. billing specialist
b. coding specialist
c. health information
R
specialist
d. reimbursement specialist
ANSWER: d
EG
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJEC UHI_GREEN_24_1.3 - Identify career opportunities available for
TIVES: health insurance specialists.
DATE CREATED: 12/11/2023 3:17 PM
U
DATE MODIFIED: 12/11/2023 3:17 PM
5. A claims examiner is employed by a
ID
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.
ES
ANSWER: d
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJEC UHI_GREEN_24_1.3 - Identify career opportunities available for
TIVES: health insurance specialists.
DATE CREATED: 12/11/2023 3:17 PM
DATE MODIFIED: 12/11/2023 3:17 PM
6. Which involves linking every procedure or service code reported on the claim to a condition code that justifies the
reason for performing that procedure or service?
a. claims adjudication
