NCCT REVIEW | MEDICAL INSURANCE EXAM QU
COMPLETE ANSWERS
Place cthe coptions cbelow cin corder cof cclaim csubmission, cwhere call cinsurances care crelevant.
Humana
ABC cAuto
Medicaid
Medicare c- cCORRECT cANS✔✔ABC cAuto
Humana
Medicare
Medicaid
It cis chighly cunlikely cthat ca cpatient cwould chave call cfour cof cthese cinsurances. cHowever, cif cthey c
cclaims care csubmitted cis crelevant. cIt cis cassumed cthat csince cthere cis cauto cinsurance cinvolved, c
can cautomobile caccident. cThe cauto cinsurance cshould cbe cfiled cfirst. cHumana, ca cprivate cpayer, c
cGovernment cinsurance, csuch cas cMedicare cand cMedicaid, cshould calways cbe csubmitted clast. cW
cMedicaid care cvalid, cMedicaid cshould cbe cbilled clast.
Eligibility cfor cMedicaid cmay cchange cas cquickly cas
A. cdaily.
B. cweekly.
C. cmonthly.
D. cyearly. c- cCORRECT cANS✔✔C. cmonthly.
Medicaid ccoverage cdetermination cis cmonthly. cFor cexample, cif ca cperson cis celigible cfor ccoverag
celigible cfor ccoverage con cApril c25. cEligibility cwill cnot cchange cmore cor cless cfrequently cthan cmo
Which cof cthe cfollowing cprocesses crequires cchecking cand cconfirming cthat cthe cpatient cis ca cmem
cand cthat cthe cmember cidentification cnumber cis ccorrect?
A. cprecertification
B. cprior cauthorization
C. cverification
D. creferral c- cCORRECT cANS✔✔C. cverification
The cprocess cof cinsurance cverification cis cthe cconfirmation cthat cthe cpatient cis ca cmember cof cthe
cmember cidentification cnumber cis ccorrect. cThis cprocess cshould cbe cdone cevery ctime cthe cpatien
cinsurance ccan cchange cat cany ctime. cPrecertification cis cobtained cfor cparticular cservices cand cis
ccompany cprior cto cthose cservices cbeing crendered. cPrecertification chas cto cdo cwith cmedical cnec
cpatient's cdiagnosis cis ca cproper creason cto chave ca cservice. cPrior cauthorization cis cthe capproval
cto cprovide ca cservice. cA creferral cis crequired cfor csome cpatients cto csee ca cspecialist. cNot call cins
, Which cof cthe cfollowing cstatements cis ctrue cconcerning ca ccourt corder cabout cchildren's chealth cco
A. cThe cprimary cplan cbelongs cto cthe cparent cwhose cbirthday cfalls cclosest cto cthe cbeginning cof ct
B. cDivorce crulings chave cno ceffect con cprimary cand csecondary cpolices.
C. cThe cprimary cplan cbelongs cto cthe cparent cwhose cpolicy cwas ceffective cthe clongest.
D. cDivorce crulings coverride cthe cbirthday crule. c- cCORRECT cANS✔✔D. cDivorce crulings coverride
Usually, cwhen cassessing cthe ccoordination cof cbenefits, cthe cbirthday crule cis cused cto cdetermine
cchild. cHowever, cduring ca cdivorce, ca cjudge cmay crule cwhich cparent cis cprimarily cresponsible cfor
cDivorce cDivorce crulings coverride cthe cbirthday crule.
If ca cmarried ccouple cis ccovered cunder cboth cspouses' chealth cinsurance cand cthe chusband cis cpic
chimself, che cshould
A. cget cto cpick cwhich cinsurance cbenefits cto cuse cat cthe cpharmacy.
B. cuse cthe cinsurance cbenefits cwith cthe cleast cexpensive cout cof cpocket cexpense.
C. cuse chis cinsurance cbenefits calone cunless che cforgot cto cbring cthe cinsurance ccard.
D. cuse cboth cof cinsurance cbenefits cas cthey capply cto cthis cpharmacy cpurchase. c- cCORRECT cAN
cinsurance cbenefits cas cthey capply cto cthis cpharmacy cpurchase.
The cpatient cshould cuse chis cinsurance cas cprimary cand cthen cshould cuse chis cspouse's cinsuranc
cprescription ccoverage.
A cpatient chas cjust cleft cthe cdoctor's coffice cwith ca cnew cprescription cafter ca cscheduled cfollow cup
cinsurance ccovers cthe cbill ccompletely, cher csecondary cinsurance cpolicy
A. cis cstill cgoing cto cbe cbilled cfor cthe cmedications.
B. cis cstill cgoing cto cpay cthe cfee cschedule camount cfor cthe cvisit.
C. cwill cnot cbe cused cfor cthis cvisit.
D. cwill capply cthe cprimary cpayment cto cthe clifetime cmaximum camount. c- cCORRECT cANS✔✔C.
Once cpayment chas cbeen creceived cfrom cthe cinsurance ccompany cand cthere cis cnot ca cbalance, c
cthe csecondary cinsurance ccompany.
The cMedicare cSecondary cPayer cQuestionnaire cis ca cform cthat
A. cpatients cfill cout cto cdetermine cif cthere cis cother cinsurance cdesignated cas cthe cprimary cinsuran
B. cthe cmedical coffice cstaff cfills cout cto cdetermine cif cpatient cis celigible cfor cMedicare cbenefits.
C. cthe cmedical coffice cstaff cfills cout cwhen cthey chave cconfirmed cthat cthe cpatient chas cMedicare c
cprovider.
D. cthe cprovider cfills cout cwhen cthey care cnot csure cif cthe cpatient chas cother cinsurance. c- cCORRE
cto cdetermine cif cthere cis cother cinsurance cdesignated cas cthe cprimary cinsurance.
Providers cmust cdetermine cif cMedicare cis cthe cprimary cor csecondary cpayer. cThe cbeneficiary cmu
cpossible ccoverage cthat cmay cbe cprimary cto cMedicare. cIt cis crecommended cthat cthe cCMS cMedi
cQuestionnaire, cor ca cquestionnaire cthat casks csimilar ctypes cof cquestions, cis cused.
Which cof cthe cfollowing cshould cthe cinsurance cand ccoding cspecialist ccheck cin corder cto cdetermin
cbilled cas cprimary cor csecondary?
A. cthe ceffective cpolicy cdate cfor ceach ccarrier
B. cCOB
C. cAOB
D. cthe cpatient's cemployer c- cCORRECT cANS✔✔B. cCOB
COB cstands cfor cCoordination cof cBenefits cand cdetermines cthe corder cin cwhich cthe cinsurance cs
cThe cacronym cAOB cstands cfor cAssignment cof cBenefits, cwhich chas cto cdo cwith cwho cthe cpayme
cbilled. cThe cpolicy cdate cand cemployer chave cno ceffect con cthe cCoordination cof cBenefits.
Which cof cthe cfollowing cstatements cis ctrue cfor can cemployee con cMedicare cif che cchooses ccover
cgroup cplan?
A. cClaims cshould conly cbe csubmitted cto cMedicare.
B. cThe cgroup cplan cwill creject ccoverage cand cMedicare cwill cpay c20%.
COMPLETE ANSWERS
Place cthe coptions cbelow cin corder cof cclaim csubmission, cwhere call cinsurances care crelevant.
Humana
ABC cAuto
Medicaid
Medicare c- cCORRECT cANS✔✔ABC cAuto
Humana
Medicare
Medicaid
It cis chighly cunlikely cthat ca cpatient cwould chave call cfour cof cthese cinsurances. cHowever, cif cthey c
cclaims care csubmitted cis crelevant. cIt cis cassumed cthat csince cthere cis cauto cinsurance cinvolved, c
can cautomobile caccident. cThe cauto cinsurance cshould cbe cfiled cfirst. cHumana, ca cprivate cpayer, c
cGovernment cinsurance, csuch cas cMedicare cand cMedicaid, cshould calways cbe csubmitted clast. cW
cMedicaid care cvalid, cMedicaid cshould cbe cbilled clast.
Eligibility cfor cMedicaid cmay cchange cas cquickly cas
A. cdaily.
B. cweekly.
C. cmonthly.
D. cyearly. c- cCORRECT cANS✔✔C. cmonthly.
Medicaid ccoverage cdetermination cis cmonthly. cFor cexample, cif ca cperson cis celigible cfor ccoverag
celigible cfor ccoverage con cApril c25. cEligibility cwill cnot cchange cmore cor cless cfrequently cthan cmo
Which cof cthe cfollowing cprocesses crequires cchecking cand cconfirming cthat cthe cpatient cis ca cmem
cand cthat cthe cmember cidentification cnumber cis ccorrect?
A. cprecertification
B. cprior cauthorization
C. cverification
D. creferral c- cCORRECT cANS✔✔C. cverification
The cprocess cof cinsurance cverification cis cthe cconfirmation cthat cthe cpatient cis ca cmember cof cthe
cmember cidentification cnumber cis ccorrect. cThis cprocess cshould cbe cdone cevery ctime cthe cpatien
cinsurance ccan cchange cat cany ctime. cPrecertification cis cobtained cfor cparticular cservices cand cis
ccompany cprior cto cthose cservices cbeing crendered. cPrecertification chas cto cdo cwith cmedical cnec
cpatient's cdiagnosis cis ca cproper creason cto chave ca cservice. cPrior cauthorization cis cthe capproval
cto cprovide ca cservice. cA creferral cis crequired cfor csome cpatients cto csee ca cspecialist. cNot call cins
, Which cof cthe cfollowing cstatements cis ctrue cconcerning ca ccourt corder cabout cchildren's chealth cco
A. cThe cprimary cplan cbelongs cto cthe cparent cwhose cbirthday cfalls cclosest cto cthe cbeginning cof ct
B. cDivorce crulings chave cno ceffect con cprimary cand csecondary cpolices.
C. cThe cprimary cplan cbelongs cto cthe cparent cwhose cpolicy cwas ceffective cthe clongest.
D. cDivorce crulings coverride cthe cbirthday crule. c- cCORRECT cANS✔✔D. cDivorce crulings coverride
Usually, cwhen cassessing cthe ccoordination cof cbenefits, cthe cbirthday crule cis cused cto cdetermine
cchild. cHowever, cduring ca cdivorce, ca cjudge cmay crule cwhich cparent cis cprimarily cresponsible cfor
cDivorce cDivorce crulings coverride cthe cbirthday crule.
If ca cmarried ccouple cis ccovered cunder cboth cspouses' chealth cinsurance cand cthe chusband cis cpic
chimself, che cshould
A. cget cto cpick cwhich cinsurance cbenefits cto cuse cat cthe cpharmacy.
B. cuse cthe cinsurance cbenefits cwith cthe cleast cexpensive cout cof cpocket cexpense.
C. cuse chis cinsurance cbenefits calone cunless che cforgot cto cbring cthe cinsurance ccard.
D. cuse cboth cof cinsurance cbenefits cas cthey capply cto cthis cpharmacy cpurchase. c- cCORRECT cAN
cinsurance cbenefits cas cthey capply cto cthis cpharmacy cpurchase.
The cpatient cshould cuse chis cinsurance cas cprimary cand cthen cshould cuse chis cspouse's cinsuranc
cprescription ccoverage.
A cpatient chas cjust cleft cthe cdoctor's coffice cwith ca cnew cprescription cafter ca cscheduled cfollow cup
cinsurance ccovers cthe cbill ccompletely, cher csecondary cinsurance cpolicy
A. cis cstill cgoing cto cbe cbilled cfor cthe cmedications.
B. cis cstill cgoing cto cpay cthe cfee cschedule camount cfor cthe cvisit.
C. cwill cnot cbe cused cfor cthis cvisit.
D. cwill capply cthe cprimary cpayment cto cthe clifetime cmaximum camount. c- cCORRECT cANS✔✔C.
Once cpayment chas cbeen creceived cfrom cthe cinsurance ccompany cand cthere cis cnot ca cbalance, c
cthe csecondary cinsurance ccompany.
The cMedicare cSecondary cPayer cQuestionnaire cis ca cform cthat
A. cpatients cfill cout cto cdetermine cif cthere cis cother cinsurance cdesignated cas cthe cprimary cinsuran
B. cthe cmedical coffice cstaff cfills cout cto cdetermine cif cpatient cis celigible cfor cMedicare cbenefits.
C. cthe cmedical coffice cstaff cfills cout cwhen cthey chave cconfirmed cthat cthe cpatient chas cMedicare c
cprovider.
D. cthe cprovider cfills cout cwhen cthey care cnot csure cif cthe cpatient chas cother cinsurance. c- cCORRE
cto cdetermine cif cthere cis cother cinsurance cdesignated cas cthe cprimary cinsurance.
Providers cmust cdetermine cif cMedicare cis cthe cprimary cor csecondary cpayer. cThe cbeneficiary cmu
cpossible ccoverage cthat cmay cbe cprimary cto cMedicare. cIt cis crecommended cthat cthe cCMS cMedi
cQuestionnaire, cor ca cquestionnaire cthat casks csimilar ctypes cof cquestions, cis cused.
Which cof cthe cfollowing cshould cthe cinsurance cand ccoding cspecialist ccheck cin corder cto cdetermin
cbilled cas cprimary cor csecondary?
A. cthe ceffective cpolicy cdate cfor ceach ccarrier
B. cCOB
C. cAOB
D. cthe cpatient's cemployer c- cCORRECT cANS✔✔B. cCOB
COB cstands cfor cCoordination cof cBenefits cand cdetermines cthe corder cin cwhich cthe cinsurance cs
cThe cacronym cAOB cstands cfor cAssignment cof cBenefits, cwhich chas cto cdo cwith cwho cthe cpayme
cbilled. cThe cpolicy cdate cand cemployer chave cno ceffect con cthe cCoordination cof cBenefits.
Which cof cthe cfollowing cstatements cis ctrue cfor can cemployee con cMedicare cif che cchooses ccover
cgroup cplan?
A. cClaims cshould conly cbe csubmitted cto cMedicare.
B. cThe cgroup cplan cwill creject ccoverage cand cMedicare cwill cpay c20%.
