Test Bank
,Name: Class: Date:
Chapter 01: Health Insurance Specialist Career
1. If the insurance plan has a hold harmless clause, it means that the patient
a. is charged for fees by the health care provider, per the EOB.
b. automatically has lower out-of-pocket health care expenses.
c. is not responsible for paying what the insurance plan denies.
d. was required to pay any amounts that the insurance plan denies.
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and
the parties involved.
DATE CREATED: 11/1/2022 11:32 AM
DATE MODIFIED: 11/1/2022 11:32 AM
2. The process of reporting __________ as numeric and alphanumeric characters on the insurance claim is called coding.
a. dates of service for procedures
b. diagnoses and procedures/services
c. health insurance claims identifiers
d. national provider identifiers
ANSWER: b
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and
the parties involved.
DATE CREATED: 11/1/2022 11:32 AM
DATE MODIFIED: 11/1/2022 11:32 AM
3. A claims examiner employed by a third-party payer reviews health-related claims to determine whether the charges are
reasonable, in addition to
a. assigning ICD-10-CM and CPT codes.
b. billing patients for copayments and coinsurance.
c. determining medical necessity of services/procedures.
d. resubmitting denied claims to health care providers.
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and
the parties involved.
UHI_GREEN_24_1.3 - Identify career opportunities available for health insurance
specialists.
DATE CREATED: 11/1/2022 11:32 AM
DATE MODIFIED: 11/1/2022 11:32 AM
Page 1
,Name: Class: Date:
Chapter 01: Health Insurance Specialist Career
4. Which is another name for a health insurance specialist?
a. billing specialist
b. coding specialist
c. health information specialist
d. reimbursement specialist
ANSWER: d
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.3 - Identify career opportunities available for health insurance
specialists.
DATE CREATED: 11/1/2022 11:32 AM
DATE MODIFIED: 11/1/2022 11:32 AM
5. A claims examiner is employed by a
a. facility to submit claims.
b. governmental agency to process claims.
c. physician’s office to submit claims.
d. third-party payer to review claims.
ANSWER: d
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.3 - Identify career opportunities available for health insurance
specialists.
DATE CREATED: 11/1/2022 11:32 AM
DATE MODIFIED: 11/1/2022 11:32 AM
6. Which involves linking every procedure or service code reported on the claim to a condition code that justifies the
necessity of performing that procedure or service?
a. claims adjudication
b. diagnosis coding
c. medical necessity
d. reimbursement processing
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and
the parties involved.
DATE CREATED: 11/1/2022 11:32 AM
DATE MODIFIED: 11/1/2022 11:32 AM
Page 2
, Name: Class: Date:
Chapter 01: Health Insurance Specialist Career
7. The CPT manual is published by the
a. American Billing Association.
b. American Board of Physicians.
c. American Dental Association.
d. American Medical Association.
ANSWER: d
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and
the parties involved.
DATE CREATED: 11/1/2022 11:32 AM
DATE MODIFIED: 11/1/2022 11:32 AM
8. Which is submitted to the payer requesting reimbursement?
a. explanation of benefits
b. health insurance claim
c. remittance advice
d. prior approval form
ANSWER: b
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.5 - Describe the job responsibilities of a health insurance
specialist.
DATE CREATED: 11/1/2022 11:32 AM
DATE MODIFIED: 11/1/2022 11:32 AM
9. The Centers for Medicare and Medicaid Services (CMS) agency is located in the __________.
a. ACF
b. DHHS
c. FDA
d. OIG
ANSWER: b
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and
the parties involved.
DATE CREATED: 11/1/2022 11:32 AM
DATE MODIFIED: 11/1/2022 11:32 AM
10. When a health insurance plan’s prior approval requirements are not met by providers,
Page 3
,Name: Class: Date:
Chapter 01: Health Insurance Specialist Career
1. If the insurance plan has a hold harmless clause, it means that the patient
a. is charged for fees by the health care provider, per the EOB.
b. automatically has lower out-of-pocket health care expenses.
c. is not responsible for paying what the insurance plan denies.
d. was required to pay any amounts that the insurance plan denies.
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and
the parties involved.
DATE CREATED: 11/1/2022 11:32 AM
DATE MODIFIED: 11/1/2022 11:32 AM
2. The process of reporting __________ as numeric and alphanumeric characters on the insurance claim is called coding.
a. dates of service for procedures
b. diagnoses and procedures/services
c. health insurance claims identifiers
d. national provider identifiers
ANSWER: b
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and
the parties involved.
DATE CREATED: 11/1/2022 11:32 AM
DATE MODIFIED: 11/1/2022 11:32 AM
3. A claims examiner employed by a third-party payer reviews health-related claims to determine whether the charges are
reasonable, in addition to
a. assigning ICD-10-CM and CPT codes.
b. billing patients for copayments and coinsurance.
c. determining medical necessity of services/procedures.
d. resubmitting denied claims to health care providers.
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and
the parties involved.
UHI_GREEN_24_1.3 - Identify career opportunities available for health insurance
specialists.
DATE CREATED: 11/1/2022 11:32 AM
DATE MODIFIED: 11/1/2022 11:32 AM
Page 1
,Name: Class: Date:
Chapter 01: Health Insurance Specialist Career
4. Which is another name for a health insurance specialist?
a. billing specialist
b. coding specialist
c. health information specialist
d. reimbursement specialist
ANSWER: d
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.3 - Identify career opportunities available for health insurance
specialists.
DATE CREATED: 11/1/2022 11:32 AM
DATE MODIFIED: 11/1/2022 11:32 AM
5. A claims examiner is employed by a
a. facility to submit claims.
b. governmental agency to process claims.
c. physician’s office to submit claims.
d. third-party payer to review claims.
ANSWER: d
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.3 - Identify career opportunities available for health insurance
specialists.
DATE CREATED: 11/1/2022 11:32 AM
DATE MODIFIED: 11/1/2022 11:32 AM
6. Which involves linking every procedure or service code reported on the claim to a condition code that justifies the
necessity of performing that procedure or service?
a. claims adjudication
b. diagnosis coding
c. medical necessity
d. reimbursement processing
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and
the parties involved.
DATE CREATED: 11/1/2022 11:32 AM
DATE MODIFIED: 11/1/2022 11:32 AM
Page 2
, Name: Class: Date:
Chapter 01: Health Insurance Specialist Career
7. The CPT manual is published by the
a. American Billing Association.
b. American Board of Physicians.
c. American Dental Association.
d. American Medical Association.
ANSWER: d
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and
the parties involved.
DATE CREATED: 11/1/2022 11:32 AM
DATE MODIFIED: 11/1/2022 11:32 AM
8. Which is submitted to the payer requesting reimbursement?
a. explanation of benefits
b. health insurance claim
c. remittance advice
d. prior approval form
ANSWER: b
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.5 - Describe the job responsibilities of a health insurance
specialist.
DATE CREATED: 11/1/2022 11:32 AM
DATE MODIFIED: 11/1/2022 11:32 AM
9. The Centers for Medicare and Medicaid Services (CMS) agency is located in the __________.
a. ACF
b. DHHS
c. FDA
d. OIG
ANSWER: b
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and
the parties involved.
DATE CREATED: 11/1/2022 11:32 AM
DATE MODIFIED: 11/1/2022 11:32 AM
10. When a health insurance plan’s prior approval requirements are not met by providers,
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