NCCT INTERACTIVE REVIEW MEDICAL INSURANCE EXAM
QUESTIONS AND ANSWERS
Eligibility for Medicaid may change as quickly as
monthly.
Which of the following processes requires checking and confirming that the
patient is a member of the insurance plan and that the member identification
number is correct?
verification
The patient is a 3-year-old. Both parents have private insurance coverage on the
patient, and the mother has a Healthcare Savings Account. The primary insurance
belongs to the parent
with the earlier birthday in the year.
A child was seen by her pediatrician. The child is covered under both her father's
and mother's insurance. According to the "Birthday Rule," the mother's insurance
is primary. Why?
The mother's birthday comes first in the calendar year.
Which of the following statements is true concerning a court order about
children's health coverage after a divorce?
Divorce rulings override the birthday rule.
If a married couple is covered under both spouses' health insurance and the
husband is picking up a prescription for himself, he should
use both of insurance benefits as they apply to this pharmacy purchase.
A patient has just left the doctor's office with a new prescription after a scheduled
follow up visit. If the patient's primary insurance covers the bill completely, her
secondary insurance policy
will not be used for this visit.
The Medicare Secondary Payer Questionnaire is a form that
patients fill out to determine if there is other insurance designated as the primary
insurance.
,Which of the following should the insurance and coding specialist check in order
to determine which payer should be billed as primary or secondary?
COB: COB stands for Coordination of Benefits and determines the order in which the
insurance specialist should bill the payers.
Which of the following statements is true for an employee on Medicare if he
chooses coverage under the employer's group plan?
The group plan will be primary and Medicare will be secondary.
Which of the following determines the primary policy if two plans cover a
dependent child?
The parent who has the first birthdate of the year.
The patient had United Health Care HMO group insurance before she retired.
Today she presented her Medicare Part B insurance card and her husband's Blue
Cross Blue Shield PPO group insurance card to the insurance and coding
specialist. Which of the following is the patient's primary insurance for today's
visit?
Blue Cross Blue Shield PPO:
Medicare Part B is not primary when the patient is part of a group sponsored health
plan. United Health Care HMO is not in effect as the scenario indicates that the patient
"had" the plan. Blue Cross Blue Shield PPO is primary to Medicare when the patient is
part of a group sponsored health insurance plan and would be the correct response.
Medicare Part A would not be correct because it is not mentioned in the scenario and is
not used for office (outpatient) services.
A patient was hurt at work and seen in the physician's office today. The patient is
covered under Medicare and BCBS and is also covered under Workers'
Compensation for this injury. Which of the following is the primary insurance and
the secondary insurance?
Worker's Compensation is the primary, BCBS is the secondary:
The patient was injured at work so Worker's Compensation is the primary insurance
carrier. Once the claim is processed through Worker's Compensation, it would follow the
, standard of the patient's health insurance claim process. Since the patient is working
and covered under the employers' policy, the claim should be filed with BCBS as the
next step of submission and the claim would be filed with Medicare last.
Place the options below in order of claim submission, where all insurances are
relevant. (Click and drag the options in the left column to their correct position in
the right column.): Medicare, Medicaid, Humana, ABC Auto
ABC Auto, Humana, Medicare, Medicaid:
It is highly unlikely that a patient would have all four of these insurances. However, if
they do, the order in which the claims are submitted is relevant. It is assumed that since
there is auto insurance involved, that this claim has to do with an automobile accident.
The auto insurance should be filed first. Humana, a private payer, should be filed next.
Government insurance, such as Medicare and Medicaid, should always be submitted
last. When both Medicare and Medicaid are valid, Medicaid should be billed last.
After a patient is seen for a follow up visit, the physician orders additional
diagnostic testing. Which of the following does the insurance and coding
specialist need to obtain?
pre-authorization:
A billing and coding specialist must obtain a pre-authorization for the diagnostic testing.
A pre-authorization is approval from the insurance company for the testing to be done.
An allowed amount is not obtained until receiving the explanation of benefits, after the
service is completed. A referral is needed to see a specialist, in some situations, and is
provided by the primary care physician. An advanced beneficiary notice is a statement
that is signed by the patient when it is known that the insurance company will not pay
for the service and the patient is electing to have the service anyway. It is a promise that
the patient will pay for the services in full.
A patient is referred to a specialist by the primary care provider. Pre-certification
is required for this patient's specialty visit. Which of the following actions is
required by the insurance and coding specialist to obtain authorization?
QUESTIONS AND ANSWERS
Eligibility for Medicaid may change as quickly as
monthly.
Which of the following processes requires checking and confirming that the
patient is a member of the insurance plan and that the member identification
number is correct?
verification
The patient is a 3-year-old. Both parents have private insurance coverage on the
patient, and the mother has a Healthcare Savings Account. The primary insurance
belongs to the parent
with the earlier birthday in the year.
A child was seen by her pediatrician. The child is covered under both her father's
and mother's insurance. According to the "Birthday Rule," the mother's insurance
is primary. Why?
The mother's birthday comes first in the calendar year.
Which of the following statements is true concerning a court order about
children's health coverage after a divorce?
Divorce rulings override the birthday rule.
If a married couple is covered under both spouses' health insurance and the
husband is picking up a prescription for himself, he should
use both of insurance benefits as they apply to this pharmacy purchase.
A patient has just left the doctor's office with a new prescription after a scheduled
follow up visit. If the patient's primary insurance covers the bill completely, her
secondary insurance policy
will not be used for this visit.
The Medicare Secondary Payer Questionnaire is a form that
patients fill out to determine if there is other insurance designated as the primary
insurance.
,Which of the following should the insurance and coding specialist check in order
to determine which payer should be billed as primary or secondary?
COB: COB stands for Coordination of Benefits and determines the order in which the
insurance specialist should bill the payers.
Which of the following statements is true for an employee on Medicare if he
chooses coverage under the employer's group plan?
The group plan will be primary and Medicare will be secondary.
Which of the following determines the primary policy if two plans cover a
dependent child?
The parent who has the first birthdate of the year.
The patient had United Health Care HMO group insurance before she retired.
Today she presented her Medicare Part B insurance card and her husband's Blue
Cross Blue Shield PPO group insurance card to the insurance and coding
specialist. Which of the following is the patient's primary insurance for today's
visit?
Blue Cross Blue Shield PPO:
Medicare Part B is not primary when the patient is part of a group sponsored health
plan. United Health Care HMO is not in effect as the scenario indicates that the patient
"had" the plan. Blue Cross Blue Shield PPO is primary to Medicare when the patient is
part of a group sponsored health insurance plan and would be the correct response.
Medicare Part A would not be correct because it is not mentioned in the scenario and is
not used for office (outpatient) services.
A patient was hurt at work and seen in the physician's office today. The patient is
covered under Medicare and BCBS and is also covered under Workers'
Compensation for this injury. Which of the following is the primary insurance and
the secondary insurance?
Worker's Compensation is the primary, BCBS is the secondary:
The patient was injured at work so Worker's Compensation is the primary insurance
carrier. Once the claim is processed through Worker's Compensation, it would follow the
, standard of the patient's health insurance claim process. Since the patient is working
and covered under the employers' policy, the claim should be filed with BCBS as the
next step of submission and the claim would be filed with Medicare last.
Place the options below in order of claim submission, where all insurances are
relevant. (Click and drag the options in the left column to their correct position in
the right column.): Medicare, Medicaid, Humana, ABC Auto
ABC Auto, Humana, Medicare, Medicaid:
It is highly unlikely that a patient would have all four of these insurances. However, if
they do, the order in which the claims are submitted is relevant. It is assumed that since
there is auto insurance involved, that this claim has to do with an automobile accident.
The auto insurance should be filed first. Humana, a private payer, should be filed next.
Government insurance, such as Medicare and Medicaid, should always be submitted
last. When both Medicare and Medicaid are valid, Medicaid should be billed last.
After a patient is seen for a follow up visit, the physician orders additional
diagnostic testing. Which of the following does the insurance and coding
specialist need to obtain?
pre-authorization:
A billing and coding specialist must obtain a pre-authorization for the diagnostic testing.
A pre-authorization is approval from the insurance company for the testing to be done.
An allowed amount is not obtained until receiving the explanation of benefits, after the
service is completed. A referral is needed to see a specialist, in some situations, and is
provided by the primary care physician. An advanced beneficiary notice is a statement
that is signed by the patient when it is known that the insurance company will not pay
for the service and the patient is electing to have the service anyway. It is a promise that
the patient will pay for the services in full.
A patient is referred to a specialist by the primary care provider. Pre-certification
is required for this patient's specialty visit. Which of the following actions is
required by the insurance and coding specialist to obtain authorization?
