INSURANCE CLAIMS EXAMINATION QUESTIONS AND
CORRECT ANSWER WITH EXPLANATION GRADED A+
STUDY GUIDE SOUTHERN NEW HAMPSHIRE UNIVERSITY
1. An insurance claim is:
A. A request for payment submitted to an insurance company
B. A payroll report only
C. A parking permit only
D. A cafeteria inventory form only
Answer: A
Rationale: Insurance claims are used to obtain reimbursement for services provided.
2. The primary purpose of insurance claims processing is to:
A. Determine payment responsibility for healthcare services
B. Eliminate patient records
C. Manage landscaping only
D. Schedule employee vacations only
Answer: A
Rationale: Claims processing ensures appropriate reimbursement.
3. A clean claim is one that:
A. Contains complete and accurate information
B. Is missing patient information
C. Requires multiple corrections
D. Is submitted after deadlines
Answer: A
Rationale: Clean claims reduce delays and denials.
4. Insurance verification is performed to:
,A. Confirm patient coverage and benefits
B. Eliminate coding requirements
C. Reduce patient communication
D. Ignore reimbursement policies
Answer: A
Rationale: Verification prevents claim denials.
5. ICD-10 codes are used to report:
A. Diagnoses and medical conditions
B. Employee schedules only
C. Parking assignments only
D. Cafeteria inventory only
Answer: A
Rationale: ICD-10 standardizes diagnostic reporting.
6. CPT codes describe:
A. Medical procedures and services
B. Insurance premiums only
C. Payroll adjustments only
D. Landscaping schedules only
Answer: A
Rationale: CPT codes standardize procedure reporting.
7. A deductible is:
A. The amount paid by the patient before insurance coverage begins
B. A hospital maintenance fee
C. An insurance company bonus
D. A parking charge only
Answer: A
Rationale: Deductibles are part of patient cost-sharing.
8. A copayment is:
, A. A fixed amount paid by the patient at the time of service
B. An insurance premium only
C. A payroll deduction only
D. A cafeteria expense only
Answer: A
Rationale: Copayments are common insurance plan requirements.
9. Claim denial occurs when:
A. An insurer refuses payment for a claim
B. A patient receives treatment
C. Coding is accurate
D. Insurance eligibility is verified
Answer: A
Rationale: Denials may result from errors or policy limitations.
10. The CMS-1500 form is commonly used for:
A. Professional healthcare claims
B. Employee payroll only
C. Parking management only
D. Landscaping projects only
Answer: A
Rationale: CMS-1500 is standard for physician billing.
11. UB-04 claim forms are primarily used by:
A. Hospitals and healthcare facilities
B. Cafeteria departments only
C. Parking enforcement only
D. Construction companies only
Answer: A
Rationale: UB-04 forms are institutional claim forms.
12. Prior authorization means:
CORRECT ANSWER WITH EXPLANATION GRADED A+
STUDY GUIDE SOUTHERN NEW HAMPSHIRE UNIVERSITY
1. An insurance claim is:
A. A request for payment submitted to an insurance company
B. A payroll report only
C. A parking permit only
D. A cafeteria inventory form only
Answer: A
Rationale: Insurance claims are used to obtain reimbursement for services provided.
2. The primary purpose of insurance claims processing is to:
A. Determine payment responsibility for healthcare services
B. Eliminate patient records
C. Manage landscaping only
D. Schedule employee vacations only
Answer: A
Rationale: Claims processing ensures appropriate reimbursement.
3. A clean claim is one that:
A. Contains complete and accurate information
B. Is missing patient information
C. Requires multiple corrections
D. Is submitted after deadlines
Answer: A
Rationale: Clean claims reduce delays and denials.
4. Insurance verification is performed to:
,A. Confirm patient coverage and benefits
B. Eliminate coding requirements
C. Reduce patient communication
D. Ignore reimbursement policies
Answer: A
Rationale: Verification prevents claim denials.
5. ICD-10 codes are used to report:
A. Diagnoses and medical conditions
B. Employee schedules only
C. Parking assignments only
D. Cafeteria inventory only
Answer: A
Rationale: ICD-10 standardizes diagnostic reporting.
6. CPT codes describe:
A. Medical procedures and services
B. Insurance premiums only
C. Payroll adjustments only
D. Landscaping schedules only
Answer: A
Rationale: CPT codes standardize procedure reporting.
7. A deductible is:
A. The amount paid by the patient before insurance coverage begins
B. A hospital maintenance fee
C. An insurance company bonus
D. A parking charge only
Answer: A
Rationale: Deductibles are part of patient cost-sharing.
8. A copayment is:
, A. A fixed amount paid by the patient at the time of service
B. An insurance premium only
C. A payroll deduction only
D. A cafeteria expense only
Answer: A
Rationale: Copayments are common insurance plan requirements.
9. Claim denial occurs when:
A. An insurer refuses payment for a claim
B. A patient receives treatment
C. Coding is accurate
D. Insurance eligibility is verified
Answer: A
Rationale: Denials may result from errors or policy limitations.
10. The CMS-1500 form is commonly used for:
A. Professional healthcare claims
B. Employee payroll only
C. Parking management only
D. Landscaping projects only
Answer: A
Rationale: CMS-1500 is standard for physician billing.
11. UB-04 claim forms are primarily used by:
A. Hospitals and healthcare facilities
B. Cafeteria departments only
C. Parking enforcement only
D. Construction companies only
Answer: A
Rationale: UB-04 forms are institutional claim forms.
12. Prior authorization means:
