NHA Module 2: Insurance Eligibility and other Payer R
,. ,. ,. ,. ,. ,. ,. ,.
equirements Questions
,.
Out-of-pocket,.expenses,.must,.be,.paid,.by,.which,.of,.the,.following?,.-
,.correct,.answer,.Guarantor
Which,.of,.the,.following,.types,.of,.insurance,.plan,.can,.offer,.med,.pay?,.-
,.correct,.answer,.Auto,.insurance
Which,.if,.the,.following,.is,.not,.found,.on,.a,.patient,.insurance,.card?,.-
,.correct,.answer,.Date,.of,.birth
Which,.of,.the,.following,.providers,.must,.accept,.assignment,.for,.services,.or,.
procedures,.rendered,.to,.a,.patient?,.-,.correct,.answer,.In-network
A,.patient,.receives,.a,.gastric,.bypass,.surgery,.in,.March,,.and,.the,.yearly,.dedu
ctible,.has,.been,.met,.by,.this,.claim.,.After,.the,.procedure,,.the,.maximum,.out-
of-
pocket,.amount,.has,.also,.been,.met,.for,.the,.year.,.The,.patient,.presents,.to,.the,.
office,.in,.June,.for,.joint,.that,.costs,.$2000.,.If,.the,.coinsurance,.amount,.is,.20%
,,.which,.if,.the,.following,.amount,.is,.the,.patient's,.responsibility?,.-
,.correct,.answer,.$0,,.because,.the,.out-of-
pocket,.maximum,.has,.been,.met,,.the,.patient,.does,.not,.owe,.anything.
, Which,.of,.the,.following,.is,.a,.way,.third-
party,.insurance,.plans,.keep,.medical,.costs,.down?,.-
,.correct,.answer,.Preauthorization,,.because,.the,.service,.must,.support,.medic
al,.necessity,.for,.the,.authorization.
The,.specialist,.does,.not,.obtain,.an,.ABN,.prior,.to,.performing,.the,.service?,.-
,.correct,.answer,.GZ
What,.is,.the,.difference,.between,.in-network,.and,.out-if-
network,.providers?,.-,.correct,.answer,.In-
network,.providers,.have,.signed,.a,.contract,.with,.an,.insurance,.company.,.Th
e,.providers,.agree,.to,.accept,.a,.set,.amount,.for,.services,.provided,.called,.allo
wed,.charges.,.They,.also,.agree,.to,.write,.off,.any,.balances,.above,.the,.defined,.
patient,.responsibility.,.Out-of-
network,.providers,.gave,.not,.signed,.a,.contract,.with,.the,.insurance.,.The,.pro
vider,.is,.not,.required,.to,.write,.off,.any,.adjustments,.and,.the,.patient,.responsi
bility,.is,.higher.
According,.to,.the,.Example,.Medicare,.Premiums,.chart,,.what,.is,.the,.monthly
,.premium,.for,.an,.individual,.who,.has,.an,.income,.of,.$125,000,.on,.the,.tax,.ret
urn?,.-
,.correct,.answer,.$297.00.,.A,.monthly,.rate,.of,.$297.00,.is,.for,.an,.insurance,.of,.
$111,000,.to,.$138,000.,.A,.monthly,.rate,.of,.$148.50,.is,.for,.less,.than,.$88,000
.,.A,.monthly,.rate,.of,.$475.20,.is,.for,.income,.between,.$165,000,.and,.$500,00
0.,.A,.monthly,.rate,.of,.$386.10,.is,.for,.$138,000,.to,.$165,000.
,. ,. ,. ,. ,. ,. ,. ,.
equirements Questions
,.
Out-of-pocket,.expenses,.must,.be,.paid,.by,.which,.of,.the,.following?,.-
,.correct,.answer,.Guarantor
Which,.of,.the,.following,.types,.of,.insurance,.plan,.can,.offer,.med,.pay?,.-
,.correct,.answer,.Auto,.insurance
Which,.if,.the,.following,.is,.not,.found,.on,.a,.patient,.insurance,.card?,.-
,.correct,.answer,.Date,.of,.birth
Which,.of,.the,.following,.providers,.must,.accept,.assignment,.for,.services,.or,.
procedures,.rendered,.to,.a,.patient?,.-,.correct,.answer,.In-network
A,.patient,.receives,.a,.gastric,.bypass,.surgery,.in,.March,,.and,.the,.yearly,.dedu
ctible,.has,.been,.met,.by,.this,.claim.,.After,.the,.procedure,,.the,.maximum,.out-
of-
pocket,.amount,.has,.also,.been,.met,.for,.the,.year.,.The,.patient,.presents,.to,.the,.
office,.in,.June,.for,.joint,.that,.costs,.$2000.,.If,.the,.coinsurance,.amount,.is,.20%
,,.which,.if,.the,.following,.amount,.is,.the,.patient's,.responsibility?,.-
,.correct,.answer,.$0,,.because,.the,.out-of-
pocket,.maximum,.has,.been,.met,,.the,.patient,.does,.not,.owe,.anything.
, Which,.of,.the,.following,.is,.a,.way,.third-
party,.insurance,.plans,.keep,.medical,.costs,.down?,.-
,.correct,.answer,.Preauthorization,,.because,.the,.service,.must,.support,.medic
al,.necessity,.for,.the,.authorization.
The,.specialist,.does,.not,.obtain,.an,.ABN,.prior,.to,.performing,.the,.service?,.-
,.correct,.answer,.GZ
What,.is,.the,.difference,.between,.in-network,.and,.out-if-
network,.providers?,.-,.correct,.answer,.In-
network,.providers,.have,.signed,.a,.contract,.with,.an,.insurance,.company.,.Th
e,.providers,.agree,.to,.accept,.a,.set,.amount,.for,.services,.provided,.called,.allo
wed,.charges.,.They,.also,.agree,.to,.write,.off,.any,.balances,.above,.the,.defined,.
patient,.responsibility.,.Out-of-
network,.providers,.gave,.not,.signed,.a,.contract,.with,.the,.insurance.,.The,.pro
vider,.is,.not,.required,.to,.write,.off,.any,.adjustments,.and,.the,.patient,.responsi
bility,.is,.higher.
According,.to,.the,.Example,.Medicare,.Premiums,.chart,,.what,.is,.the,.monthly
,.premium,.for,.an,.individual,.who,.has,.an,.income,.of,.$125,000,.on,.the,.tax,.ret
urn?,.-
,.correct,.answer,.$297.00.,.A,.monthly,.rate,.of,.$297.00,.is,.for,.an,.insurance,.of,.
$111,000,.to,.$138,000.,.A,.monthly,.rate,.of,.$148.50,.is,.for,.less,.than,.$88,000
.,.A,.monthly,.rate,.of,.$475.20,.is,.for,.income,.between,.$165,000,.and,.$500,00
0.,.A,.monthly,.rate,.of,.$386.10,.is,.for,.$138,000,.to,.$165,000.
