SimChart 69 Post-Case Quiz
What is the function of a diagnosis pointer? - answer Informs the insurance carrier of
the reason for the service provided
Which statement or statements regarding the submission of insurance claims is true? -
answer Electronic claims have fewer errors than paper claims.
What is the primary reason for filing claims electronically versus using paper claims? -
answer Turnaround time for payment is decreased
When filing an insurance claim, which statement is accurate regarding the patient's
name? - answer Should match the name listed on the insurance card
Where are the procedure charges found in the medical office? - answer Fee schedule
Which code is accurate when coding bronchitis, not specified as acute or chronic? -
answerJ40
Which coding system is used in all health care settings? - answerICD-10-CM
After the claim is submitted, the explanation of benefits states there is no payment due
to deductible not met. The patient is billed for the amount due on the account and the
patient calls to ask "Why did I get a bill; I have insurance?" Which statement is best to
use when explaining their responsibility to the patient? - answer “The explanation of
benefits indicated you have a deductible that has not been met."
Suppose a patient has Medicare. The card says Part B. Which services will the patient
be responsible for, unless they have additional coverage? - answer Hospital stays
If the same patient has an office visit and the charge is 120.00. The patient has met the
annual deductible. If Medicare allows $95.00 for this service and the physician accepts
assignment on Medicare, how much money will be paid and posted in the patient
account? - answer$76.00
Rationale: Medicare Part B pays 80% of the allowed charged. $95.00 (allowed charge)
is multiplied by 80% to get the amount of $76.00 payment.
Using the above information, how much will the patient be billed for, after Medicare's
payment? - answer$14.00
Rationale: The patient has met the deductible and the physician accepts assignment.
The patients' portion of the bill is 20% of the allowed charge. $90.00 (allowed charge) is
multiplied by 20% to get $19.00.
What is the function of a diagnosis pointer? - answer Informs the insurance carrier of
the reason for the service provided
Which statement or statements regarding the submission of insurance claims is true? -
answer Electronic claims have fewer errors than paper claims.
What is the primary reason for filing claims electronically versus using paper claims? -
answer Turnaround time for payment is decreased
When filing an insurance claim, which statement is accurate regarding the patient's
name? - answer Should match the name listed on the insurance card
Where are the procedure charges found in the medical office? - answer Fee schedule
Which code is accurate when coding bronchitis, not specified as acute or chronic? -
answerJ40
Which coding system is used in all health care settings? - answerICD-10-CM
After the claim is submitted, the explanation of benefits states there is no payment due
to deductible not met. The patient is billed for the amount due on the account and the
patient calls to ask "Why did I get a bill; I have insurance?" Which statement is best to
use when explaining their responsibility to the patient? - answer “The explanation of
benefits indicated you have a deductible that has not been met."
Suppose a patient has Medicare. The card says Part B. Which services will the patient
be responsible for, unless they have additional coverage? - answer Hospital stays
If the same patient has an office visit and the charge is 120.00. The patient has met the
annual deductible. If Medicare allows $95.00 for this service and the physician accepts
assignment on Medicare, how much money will be paid and posted in the patient
account? - answer$76.00
Rationale: Medicare Part B pays 80% of the allowed charged. $95.00 (allowed charge)
is multiplied by 80% to get the amount of $76.00 payment.
Using the above information, how much will the patient be billed for, after Medicare's
payment? - answer$14.00
Rationale: The patient has met the deductible and the physician accepts assignment.
The patients' portion of the bill is 20% of the allowed charge. $90.00 (allowed charge) is
multiplied by 20% to get $19.00.
