1
mbc final Questions with Answers (100%
Correct Answers)
Which of the following fees posted to the patient's account is an example of
"usual, customary, and reasonable?"
A. billed amount
b. submitted amount
c. allowed amount
d. adjusted amount Answer: c. allowed amount
A patient has called to schedule an appointment for an office visit to see the
doctor tomorrow for an earache. It is discovered during the scheduling process
that the insurance policy on file has been cancelled. Which of the following
should the insurance and coding specialist do next?
A. advise the patient to bring current insurance information to the appointment
b. ask the patient to pay the insurance premium to the office at the time of the
visit
c. advise the patient that he will not be able to schedule an appointment with
the doctor
d. ask the patient if he is currently employed and if the cancellation is an error
Answer: A. advise the patient to bring current insurance information to the
appointment
Which of the following is the most likely cause of the deposits not agreeing
with the credits on the day sheet or the patient ledgers?
A. cash is missing
b. payment is misplaced
,2
c. the bank made an error
d. there are duplicate cards Answer: b. payment is misplaced
Collections agencies are regulated by the
A. outpatient prospective payment system
b. uniform bill of 2004
c. health care finance administration
d. fair debt collections practices act Answer: d. fair debt collections practices act
When filing an electronic insurance claim the insurance and coding specialist
processes which of the following forms?
A. CMS-1500
b. HIPAA waiver
c. encounter form
d. assignment of benefits Answer: A. CMS-1500
In order to have claims paid as quickly as possible, the insurance specialist
must be familiar with which of the following?
A. automated claims status requests
b. payer's claim processing procedures
c. reimbursement
d. prompt pay laws Answer: b. payer's claim processing procedures
When should a provider have a patient sign an ABN?
A. when a service is excluded from coverage under Medicare
,3
b. prior to treating a patient who requires emergency services that might not be
covered
c. when items may be denied prior to performing the service
d. when the service is covered under part b fee schedule Answer: c. when items
may be denied prior to performing the service
The patient is sent a statement for an office visit. The total amount of the bill is
$100 and this amount must be paid before the insurance company will pay on
the claim. which of the following is this called?
A. deductible
b. coinsurance
c. copayment
d. premium Answer: A. deductible
When a capitation account is applied to the ledger it is also known as a
A. fee for service
b. copayment amount
c. monthly premium
d. monthly prepayment amount Answer: d. monthly prepayment amount
When using an EHR system to enter CPT codes on a CMS 1500 claim form for
electronic submission, which of the following should be entered on the claim
form first?
A. the first code selected on the electronic superbly
b. the most resource-intensive procedure or service
c. the least expensive procedure or service
, 4
d. any HCPCS code Answer: b. the most resource-intensive procedure or
service
The provider is paid the same rate per patient whether or not they provide
services and no matter which services were provided. This payment is known
as
A. a deductible
b. coinsurance
c. fee for service
d. capitation Answer: d. capitation
Which of the following refers to documentation obtained from an insurance
company that allows patients to receive treatment using their benefits?
A. preauthorization
b. precertification
c. advance beneficiary notices
d. coordination of benefits Answer: A. preauthorization
Based on the CMS manual system, when updating or maintaining the billing
code database, which of the following does the "R" denote?
A. revised
b. replaced
c. repaired
d. revisited Answer: A. revised
Providers may receive payment directly from the insurance carrier by accepting
at
mbc final Questions with Answers (100%
Correct Answers)
Which of the following fees posted to the patient's account is an example of
"usual, customary, and reasonable?"
A. billed amount
b. submitted amount
c. allowed amount
d. adjusted amount Answer: c. allowed amount
A patient has called to schedule an appointment for an office visit to see the
doctor tomorrow for an earache. It is discovered during the scheduling process
that the insurance policy on file has been cancelled. Which of the following
should the insurance and coding specialist do next?
A. advise the patient to bring current insurance information to the appointment
b. ask the patient to pay the insurance premium to the office at the time of the
visit
c. advise the patient that he will not be able to schedule an appointment with
the doctor
d. ask the patient if he is currently employed and if the cancellation is an error
Answer: A. advise the patient to bring current insurance information to the
appointment
Which of the following is the most likely cause of the deposits not agreeing
with the credits on the day sheet or the patient ledgers?
A. cash is missing
b. payment is misplaced
,2
c. the bank made an error
d. there are duplicate cards Answer: b. payment is misplaced
Collections agencies are regulated by the
A. outpatient prospective payment system
b. uniform bill of 2004
c. health care finance administration
d. fair debt collections practices act Answer: d. fair debt collections practices act
When filing an electronic insurance claim the insurance and coding specialist
processes which of the following forms?
A. CMS-1500
b. HIPAA waiver
c. encounter form
d. assignment of benefits Answer: A. CMS-1500
In order to have claims paid as quickly as possible, the insurance specialist
must be familiar with which of the following?
A. automated claims status requests
b. payer's claim processing procedures
c. reimbursement
d. prompt pay laws Answer: b. payer's claim processing procedures
When should a provider have a patient sign an ABN?
A. when a service is excluded from coverage under Medicare
,3
b. prior to treating a patient who requires emergency services that might not be
covered
c. when items may be denied prior to performing the service
d. when the service is covered under part b fee schedule Answer: c. when items
may be denied prior to performing the service
The patient is sent a statement for an office visit. The total amount of the bill is
$100 and this amount must be paid before the insurance company will pay on
the claim. which of the following is this called?
A. deductible
b. coinsurance
c. copayment
d. premium Answer: A. deductible
When a capitation account is applied to the ledger it is also known as a
A. fee for service
b. copayment amount
c. monthly premium
d. monthly prepayment amount Answer: d. monthly prepayment amount
When using an EHR system to enter CPT codes on a CMS 1500 claim form for
electronic submission, which of the following should be entered on the claim
form first?
A. the first code selected on the electronic superbly
b. the most resource-intensive procedure or service
c. the least expensive procedure or service
, 4
d. any HCPCS code Answer: b. the most resource-intensive procedure or
service
The provider is paid the same rate per patient whether or not they provide
services and no matter which services were provided. This payment is known
as
A. a deductible
b. coinsurance
c. fee for service
d. capitation Answer: d. capitation
Which of the following refers to documentation obtained from an insurance
company that allows patients to receive treatment using their benefits?
A. preauthorization
b. precertification
c. advance beneficiary notices
d. coordination of benefits Answer: A. preauthorization
Based on the CMS manual system, when updating or maintaining the billing
code database, which of the following does the "R" denote?
A. revised
b. replaced
c. repaired
d. revisited Answer: A. revised
Providers may receive payment directly from the insurance carrier by accepting
at
