Solution and Answer Guide
MICHELLE A. GREEN, UNDERSTANDING HEALTH INSURANCE: A GUIDE TO BILLING AND
REIMBURSEMENT: 2024, 19TH EDITION, 9780357932063;
CHAPTER 1: HEALTH INSURANCE SPECIALIST CAREER
TABLE OF CONTENTS
Review ............................................................... 1
1.1: Multiple Choice ............................................... 1
1.2: Professionalism .............................................. 13
EXAMS INCLUDE:MULTIPLE CHOICE QUESTIONS (MCQS): THESE ARE FREQUENTLY USED TO ASSESS STUDENTS’ UNDERSTANDING OF BUSINESS TERMINOLOGY, THEORIES, AND PRINCIPLES.CASE
STUDIES: A STAPLE OF BUSINESS EXAMS, CASE STUDIES PRESENT STUDENTS WITH REAL-WORLD BUSINESS SCENARIOS AND ASK THEM TO APPLY THEIR KNOWLEDGE TO SOLVE COMPLEX
PROBLEMS. CASE STUDIES EVALUATE STUDENTS' ABILITY TO THINK CRITICALLY AND MAKE STRATEGIC DECISIONS.ESSAY/SHORT ANSWER QUESTIONS: THESE TYPES OF QUESTIONS TEST
THE STUDENT’S ABILITY TO EXPLAIN AND ANALYZE BUSINESS CONCEPTS IN A DETAILED AND COHERENT MANNER.1.3. SKILLS TESTED IN BUSINESS EXAMSCRITICAL THINKING AND
PROBLEM-SOLVING: BUSINESS EXAMS OFTEN INCLUDE CASE STUDIES THAT CHALLENGE STUDENTS TO APPLY THEORETICAL KNOWLEDGE TO REAL-LIFE SITUATIONS. THESE TESTS ASSESS
DECISION-MAKING SKILLS, AS WELL AS THE ABILITY TO EVALUATE VARIOUS BUSINESS ALTERNATIVES.QUANTITATIVE ANALYSIS: FOR SUBJECTS LIKE FINANCE OR ECONOMICS,
BUSINESS EXAMS OFTEN REQUIRE STUDENTS TO PERFORM CALCULATIONS AND INTERPRET DATA. THE ABILITY TO ANALYZE FINANCIAL STATEMENTS, PROJECT REVENUES, AND MANAGE
BUDGETS IS ESSENTIAL.COMMUNICATION AND WRITING SKILLS: BUSINESS EXAMS MAY REQUIRE STUDENTS TO PRESENT IDEAS CLEARLY AND CONCISELY. STUDENTS MUST CONVEY COMPLEX
CONCEPTS IN A WAY THAT DEMONSTRATES THEIR UNDERSTANDING OF BUSINESS PRINCIPLES.1.4. PREPARING FOR BUSINESS EXAMSPREPARING FOR BUSINESS EXAMS INVOLVES
MASTERING BOTH CONCEPTUAL UNDERSTANDING AND PRACTICAL APPLICATION. STUDENTS ARE ENCOURAGED TO STUDY THEORIES AND FRAMEWORKS BUT ALSO TO KEEP UP-TO-
REVIEW
1.1: MULTIPLE CHOICE
1. The document submitted to the payer requesting reimbursement is called a(n)
a. explanation of benefits.
b. health insurance claim.
c. remittance advice.
d. prior approval form.
ANS: b
Analysis:
a. Incorrect. The patient receives an explanation of benefits (EOB) from the
third-party payer, which is a report detailing the results of processing
a claim. A health insurance claim is the documentation submitted to a
third-party payer or government program requesting reimbursement for
the health care services provided.
b. Correct. A health insurance claim is the documentation submitted to a
third-party payer or government program requesting reimbursement for the
health care services provided.
c. Incorrect. The provider receives a remittance advice (or remit), a notice
sent by the insurance company that contains payment information about a
claim.
A health insurance claim is the documentation submitted to a third-party
payer or government program requesting reimbursement for the health care
services provided.
0
© 2025 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 1
website, in whole or in part.
, d. Incorrect. Many health insurance plans and programs require prior
approval for treatment by specialists and documentation of post-treatment
reports, and if the prior approval form is not submitted prior to
treatment, payment of the claim is denied. A health insurance claim is
the documentation submitted to a third-party payer or government program
requesting reimbursement for the health care services provided.
Analysis:
a. Incorrect. The Administration for Children and Families is an
administrative agency of the Department of Health and Human Services. The
Centers for Medicare and Medicaid Services is an administrative agency of
the Department of Health and Human Services.
b. Correct. The Centers for Medicare and Medicaid Services is an
administrative agency of the Department of Health and Human Services.
c. Incorrect. The Food and Drug Administration is an administrative agency of
the Department of Health and Human Services. The Centers for Medicare and
Medicaid Services is an administrative agency of the Department of Health
and Human Services.
d. Incorrect. The Office of the Inspector General for the Department of
Health and Human Services reports to the Secretary of the Department of
Health and Human Services and the United States Congress. The Centers for
Medicare and Medicaid Services is an administrative agency of the
Department of Health and Human Services.
2. A health care practitioner is also called a health care
a. dealer.
b. provider.
c. purveyor.
d. supplier.
ANS: b
exams include:Multiple Choice Questions (MCQs): These are frequently used to assess students’ understanding of business
terminology, theories, and principles.Case Studies: A staple of business exams, case studies present students with real-
world business scenarios and ask them to apply their knowledge to solve complex problems. Case studies evaluate students'
ability to think critically and make strategic decisions.Essay/Short Answer Questions: These types of questions test the
student’s ability to explain and analyze business concepts in a detailed and coherent manner.1.3. Skills Tested in Business
ExamsCritical Thinking and Problem-Solving: Business exams often include case studies that challenge students to apply
theoretical knowledge to real-life situations. These tests assess decision-making skills, as well as the ability to evaluate
various business alternatives.Quantitative Analysis: For subjects like finance or economics, business exams often require
students to perform calculations and interpret data. The ability to analyze financial statements, project revenues, and
manage budgets is essential.Communication and Writing Skills: Business exams may require students to present ideas clearly
and concisely. Students must convey complex concepts in a way that demonstrates their understanding of business
principles.1.4. Preparing for Business ExamsPreparing for business exams involves mastering both conceptual understanding
and practical application. Students are encouraged to study theories and frameworks but also to keep up-to-
0
© 2025 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 2
website, in whole or in part.
, 3. The Centers for Medicare and Medicaid Services (CMS) is an administrative
agency within the
a. Administration for Children and Families.
b. Department of Health and Human Services.
c. Food and Drug Administration.
d. Office of the Inspector General.
ANS: b
exams include:Multiple Choice Questions (MCQs): These are frequently used to assess students’ understanding of business
terminology, theories, and principles.Case Studies: A staple of business exams, case studies present students with real-
world business scenarios and ask them to apply their knowledge to solve complex problems. Case studies evaluate students'
ability to think critically and make strategic decisions.Essay/Short Answer Questions: These types of questions test the
student’s ability to explain and analyze business concepts in a detailed and coherent manner.1.3. Skills Tested in Business
ExamsCritical Thinking and Problem-Solving: Business exams often include case studies that challenge students to apply
theoretical knowledge to real-life situations. These tests assess decision-making skills, as well as the ability to evaluate
various business alternatives.Quantitative Analysis: For subjects like finance or economics, business exams often require
students to perform calculations and interpret data. The ability to analyze financial statements, project revenues, and
manage budgets is essential.Communication and Writing Skills: Business exams may require students to present ideas clearly
and concisely. Students must convey complex concepts in a way that demonstrates their understanding of business
principles.1.4. Preparing for Business ExamsPreparing for business exams involves mastering both conceptual understanding
and practical application. Students are encouraged to study theories and frameworks but also to keep up-to-
Analysis:
a. Incorrect. A health care dealer is an entity that purchases goods for
wholesale or retail re-selling, such as durable medical equipment. A
health care provider is a health care practitioner, such as a
physician, physician’s assistance, or nurse practitioner.
b. Correct. A health care provider is a health care practitioner, such as
a physician, physician’s assistance, or nurse practitioner.
c. Incorrect. A health care purveyor refers to an entity that sells or
deals in a particular type of goods. A health care provider is a health
care practitioner, such as a physician, physician’s assistance, or
nurse practitioner.
d. Incorrect. A health care supplier is a person or organization that sells
or supplies goods, such as durable medical equipment. A health care
provider is a health care practitioner, such as a physician, physician’s
assistance, or nurse practitioner.
0
© 2025 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 3
website, in whole or in part.
, 4. Which is the most appropriate response to a patient who calls the office and
asks to speak with the physician?
a. Politely state that the physician is busy and cannot be disturbed.
b. Explain that the physician is unavailable and ask if the patient would
like to leave a message.
c. Transfer the call to the exam room where the physician is located.
d. Offer to schedule an appointment for the patient to be seen by the
physician.
ANS: b
Analysis:
a. Incorrect. Office personnel should not state that the physician is busy
and cannot be disturbed. Office personnel should simply state that the
physician is not available and offer to take a message that will be
passed along to the physician when available.
b. Correct. Office personnel should simply state that the physician is not
available and offer to take a message that will be passed along to the
physician when available.
c. Incorrect. Unless the physician has specifically requested that a
particular patient’s call be forwarded to the exam room, the patient’s
call should be addressed by office personnel. Office personnel should
simply state that the physician is not available and offer to take a
message that will be passed along to the physician when available.
d. Incorrect. The patient may only wish to speak to the physician;
however, in many cases, the patient’s issue may be addressed by the
physician or other medical staff (e.g., nurse practitioner, physician
assistant) without the need for a patient appointment. Office personnel
should simply state that the physician is not available and offer to
take a message that will be passed along to the physician when
available.
exams include:Multiple Choice Questions (MCQs): These are frequently used to assess students’ understanding of business
terminology, theories, and principles.Case Studies: A staple of business exams, case studies present students with
real-world business scenarios and ask them to apply their knowledge to solve complex problems. Case studies evaluate
students' ability to think critically and make strategic decisions.Essay/Short Answer Questions: These types of
questions test the student’s ability to explain and analyze business concepts in a detailed and coherent manner.1.3.
Skills Tested in Business ExamsCritical Thinking and Problem-Solving: Business exams often include case studies that
challenge students to apply theoretical knowledge to real-life situations. These tests assess decision-making skills,
as well as the ability to evaluate various business alternatives.Quantitative Analysis: For subjects like finance or
economics, business exams often require students to perform calculations and interpret data. The ability to analyze
financial statements, project revenues, and manage budgets is essential.Communication and Writing Skills: Business
exams may require students to present ideas clearly and concisely. Students must convey complex concepts in a way that
demonstrates their understanding of business principles.1.4. Preparing for Business ExamsPreparing for business exams
involves mastering both conceptual understanding and practical application. Students are encouraged to study theories
and frameworks but also to keep up-to-
5. The process of assigning diagnoses, procedures, and services using numeric
and alphanumeric characters is called
a. coding.
b. data processing.
c. programming.
d. reimbursement.
ANS: a
Analysis:
a. Correct. Coding involves the assignment of numeric or alphanumeric
characters to diagnoses, procedures, and services.
b. Incorrect. Data processing is the collection and manipulation of data to
produce meaningful information. Coding involves the assignment of numeric
or alphanumeric characters to diagnoses, procedures, and services.
c. Incorrect. Programming is the process of creating executable computer
software programs that instruct the computer to perform specific tasks.
0
© 2025 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 4
website, in whole or in part.
MICHELLE A. GREEN, UNDERSTANDING HEALTH INSURANCE: A GUIDE TO BILLING AND
REIMBURSEMENT: 2024, 19TH EDITION, 9780357932063;
CHAPTER 1: HEALTH INSURANCE SPECIALIST CAREER
TABLE OF CONTENTS
Review ............................................................... 1
1.1: Multiple Choice ............................................... 1
1.2: Professionalism .............................................. 13
EXAMS INCLUDE:MULTIPLE CHOICE QUESTIONS (MCQS): THESE ARE FREQUENTLY USED TO ASSESS STUDENTS’ UNDERSTANDING OF BUSINESS TERMINOLOGY, THEORIES, AND PRINCIPLES.CASE
STUDIES: A STAPLE OF BUSINESS EXAMS, CASE STUDIES PRESENT STUDENTS WITH REAL-WORLD BUSINESS SCENARIOS AND ASK THEM TO APPLY THEIR KNOWLEDGE TO SOLVE COMPLEX
PROBLEMS. CASE STUDIES EVALUATE STUDENTS' ABILITY TO THINK CRITICALLY AND MAKE STRATEGIC DECISIONS.ESSAY/SHORT ANSWER QUESTIONS: THESE TYPES OF QUESTIONS TEST
THE STUDENT’S ABILITY TO EXPLAIN AND ANALYZE BUSINESS CONCEPTS IN A DETAILED AND COHERENT MANNER.1.3. SKILLS TESTED IN BUSINESS EXAMSCRITICAL THINKING AND
PROBLEM-SOLVING: BUSINESS EXAMS OFTEN INCLUDE CASE STUDIES THAT CHALLENGE STUDENTS TO APPLY THEORETICAL KNOWLEDGE TO REAL-LIFE SITUATIONS. THESE TESTS ASSESS
DECISION-MAKING SKILLS, AS WELL AS THE ABILITY TO EVALUATE VARIOUS BUSINESS ALTERNATIVES.QUANTITATIVE ANALYSIS: FOR SUBJECTS LIKE FINANCE OR ECONOMICS,
BUSINESS EXAMS OFTEN REQUIRE STUDENTS TO PERFORM CALCULATIONS AND INTERPRET DATA. THE ABILITY TO ANALYZE FINANCIAL STATEMENTS, PROJECT REVENUES, AND MANAGE
BUDGETS IS ESSENTIAL.COMMUNICATION AND WRITING SKILLS: BUSINESS EXAMS MAY REQUIRE STUDENTS TO PRESENT IDEAS CLEARLY AND CONCISELY. STUDENTS MUST CONVEY COMPLEX
CONCEPTS IN A WAY THAT DEMONSTRATES THEIR UNDERSTANDING OF BUSINESS PRINCIPLES.1.4. PREPARING FOR BUSINESS EXAMSPREPARING FOR BUSINESS EXAMS INVOLVES
MASTERING BOTH CONCEPTUAL UNDERSTANDING AND PRACTICAL APPLICATION. STUDENTS ARE ENCOURAGED TO STUDY THEORIES AND FRAMEWORKS BUT ALSO TO KEEP UP-TO-
REVIEW
1.1: MULTIPLE CHOICE
1. The document submitted to the payer requesting reimbursement is called a(n)
a. explanation of benefits.
b. health insurance claim.
c. remittance advice.
d. prior approval form.
ANS: b
Analysis:
a. Incorrect. The patient receives an explanation of benefits (EOB) from the
third-party payer, which is a report detailing the results of processing
a claim. A health insurance claim is the documentation submitted to a
third-party payer or government program requesting reimbursement for
the health care services provided.
b. Correct. A health insurance claim is the documentation submitted to a
third-party payer or government program requesting reimbursement for the
health care services provided.
c. Incorrect. The provider receives a remittance advice (or remit), a notice
sent by the insurance company that contains payment information about a
claim.
A health insurance claim is the documentation submitted to a third-party
payer or government program requesting reimbursement for the health care
services provided.
0
© 2025 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 1
website, in whole or in part.
, d. Incorrect. Many health insurance plans and programs require prior
approval for treatment by specialists and documentation of post-treatment
reports, and if the prior approval form is not submitted prior to
treatment, payment of the claim is denied. A health insurance claim is
the documentation submitted to a third-party payer or government program
requesting reimbursement for the health care services provided.
Analysis:
a. Incorrect. The Administration for Children and Families is an
administrative agency of the Department of Health and Human Services. The
Centers for Medicare and Medicaid Services is an administrative agency of
the Department of Health and Human Services.
b. Correct. The Centers for Medicare and Medicaid Services is an
administrative agency of the Department of Health and Human Services.
c. Incorrect. The Food and Drug Administration is an administrative agency of
the Department of Health and Human Services. The Centers for Medicare and
Medicaid Services is an administrative agency of the Department of Health
and Human Services.
d. Incorrect. The Office of the Inspector General for the Department of
Health and Human Services reports to the Secretary of the Department of
Health and Human Services and the United States Congress. The Centers for
Medicare and Medicaid Services is an administrative agency of the
Department of Health and Human Services.
2. A health care practitioner is also called a health care
a. dealer.
b. provider.
c. purveyor.
d. supplier.
ANS: b
exams include:Multiple Choice Questions (MCQs): These are frequently used to assess students’ understanding of business
terminology, theories, and principles.Case Studies: A staple of business exams, case studies present students with real-
world business scenarios and ask them to apply their knowledge to solve complex problems. Case studies evaluate students'
ability to think critically and make strategic decisions.Essay/Short Answer Questions: These types of questions test the
student’s ability to explain and analyze business concepts in a detailed and coherent manner.1.3. Skills Tested in Business
ExamsCritical Thinking and Problem-Solving: Business exams often include case studies that challenge students to apply
theoretical knowledge to real-life situations. These tests assess decision-making skills, as well as the ability to evaluate
various business alternatives.Quantitative Analysis: For subjects like finance or economics, business exams often require
students to perform calculations and interpret data. The ability to analyze financial statements, project revenues, and
manage budgets is essential.Communication and Writing Skills: Business exams may require students to present ideas clearly
and concisely. Students must convey complex concepts in a way that demonstrates their understanding of business
principles.1.4. Preparing for Business ExamsPreparing for business exams involves mastering both conceptual understanding
and practical application. Students are encouraged to study theories and frameworks but also to keep up-to-
0
© 2025 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 2
website, in whole or in part.
, 3. The Centers for Medicare and Medicaid Services (CMS) is an administrative
agency within the
a. Administration for Children and Families.
b. Department of Health and Human Services.
c. Food and Drug Administration.
d. Office of the Inspector General.
ANS: b
exams include:Multiple Choice Questions (MCQs): These are frequently used to assess students’ understanding of business
terminology, theories, and principles.Case Studies: A staple of business exams, case studies present students with real-
world business scenarios and ask them to apply their knowledge to solve complex problems. Case studies evaluate students'
ability to think critically and make strategic decisions.Essay/Short Answer Questions: These types of questions test the
student’s ability to explain and analyze business concepts in a detailed and coherent manner.1.3. Skills Tested in Business
ExamsCritical Thinking and Problem-Solving: Business exams often include case studies that challenge students to apply
theoretical knowledge to real-life situations. These tests assess decision-making skills, as well as the ability to evaluate
various business alternatives.Quantitative Analysis: For subjects like finance or economics, business exams often require
students to perform calculations and interpret data. The ability to analyze financial statements, project revenues, and
manage budgets is essential.Communication and Writing Skills: Business exams may require students to present ideas clearly
and concisely. Students must convey complex concepts in a way that demonstrates their understanding of business
principles.1.4. Preparing for Business ExamsPreparing for business exams involves mastering both conceptual understanding
and practical application. Students are encouraged to study theories and frameworks but also to keep up-to-
Analysis:
a. Incorrect. A health care dealer is an entity that purchases goods for
wholesale or retail re-selling, such as durable medical equipment. A
health care provider is a health care practitioner, such as a
physician, physician’s assistance, or nurse practitioner.
b. Correct. A health care provider is a health care practitioner, such as
a physician, physician’s assistance, or nurse practitioner.
c. Incorrect. A health care purveyor refers to an entity that sells or
deals in a particular type of goods. A health care provider is a health
care practitioner, such as a physician, physician’s assistance, or
nurse practitioner.
d. Incorrect. A health care supplier is a person or organization that sells
or supplies goods, such as durable medical equipment. A health care
provider is a health care practitioner, such as a physician, physician’s
assistance, or nurse practitioner.
0
© 2025 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 3
website, in whole or in part.
, 4. Which is the most appropriate response to a patient who calls the office and
asks to speak with the physician?
a. Politely state that the physician is busy and cannot be disturbed.
b. Explain that the physician is unavailable and ask if the patient would
like to leave a message.
c. Transfer the call to the exam room where the physician is located.
d. Offer to schedule an appointment for the patient to be seen by the
physician.
ANS: b
Analysis:
a. Incorrect. Office personnel should not state that the physician is busy
and cannot be disturbed. Office personnel should simply state that the
physician is not available and offer to take a message that will be
passed along to the physician when available.
b. Correct. Office personnel should simply state that the physician is not
available and offer to take a message that will be passed along to the
physician when available.
c. Incorrect. Unless the physician has specifically requested that a
particular patient’s call be forwarded to the exam room, the patient’s
call should be addressed by office personnel. Office personnel should
simply state that the physician is not available and offer to take a
message that will be passed along to the physician when available.
d. Incorrect. The patient may only wish to speak to the physician;
however, in many cases, the patient’s issue may be addressed by the
physician or other medical staff (e.g., nurse practitioner, physician
assistant) without the need for a patient appointment. Office personnel
should simply state that the physician is not available and offer to
take a message that will be passed along to the physician when
available.
exams include:Multiple Choice Questions (MCQs): These are frequently used to assess students’ understanding of business
terminology, theories, and principles.Case Studies: A staple of business exams, case studies present students with
real-world business scenarios and ask them to apply their knowledge to solve complex problems. Case studies evaluate
students' ability to think critically and make strategic decisions.Essay/Short Answer Questions: These types of
questions test the student’s ability to explain and analyze business concepts in a detailed and coherent manner.1.3.
Skills Tested in Business ExamsCritical Thinking and Problem-Solving: Business exams often include case studies that
challenge students to apply theoretical knowledge to real-life situations. These tests assess decision-making skills,
as well as the ability to evaluate various business alternatives.Quantitative Analysis: For subjects like finance or
economics, business exams often require students to perform calculations and interpret data. The ability to analyze
financial statements, project revenues, and manage budgets is essential.Communication and Writing Skills: Business
exams may require students to present ideas clearly and concisely. Students must convey complex concepts in a way that
demonstrates their understanding of business principles.1.4. Preparing for Business ExamsPreparing for business exams
involves mastering both conceptual understanding and practical application. Students are encouraged to study theories
and frameworks but also to keep up-to-
5. The process of assigning diagnoses, procedures, and services using numeric
and alphanumeric characters is called
a. coding.
b. data processing.
c. programming.
d. reimbursement.
ANS: a
Analysis:
a. Correct. Coding involves the assignment of numeric or alphanumeric
characters to diagnoses, procedures, and services.
b. Incorrect. Data processing is the collection and manipulation of data to
produce meaningful information. Coding involves the assignment of numeric
or alphanumeric characters to diagnoses, procedures, and services.
c. Incorrect. Programming is the process of creating executable computer
software programs that instruct the computer to perform specific tasks.
0
© 2025 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 4
website, in whole or in part.
