Module 113 Final Review
- 1.If an insured is in disagreement with the insurer for the settlement of a claim, a suit must begin within
- A.
1 year
- B.
2 years
- C.
3 years
- D.
5 years
- 2.If a payment problem develops with an insurance company and the company ignores claims and exceeds time limits to pay a claim, it is prudent to contact the
- A.
Federal insurance commissioner
- B.
State insurance commissioner
- C.
State insurance federation
- D.
Department of public service
- 3.The document together with the payment voucher that is sent to a physician who has accepted assignment of benefits is referred to as a/an
- A.
EOB
- B.
EOMB
- C.
MRA
- D.
MPS
- 4.When receiving payment from a private insurance carrier, check the amount of payment on the EOB with the
- A.
Patient's financial accounting record
- B.
Practice's day sheet
- C.
Copy of the CMS-1500 form
- D.
Patients's insurance contract
- 5.An insurance claims register provides a/an
- A.
File containing the name and address of all insurance companies
- B.
Follow-up report that is sent to the insurance companies
- C.
Follow-up procedures for insurance claims
- D.
Practice analysis
- 6.Pending or resubmitted insurance claims may be tracked through a
- A.
Tickler file
- B.
Clinical file
- C.
Data file
- D.
Patient file
- 7.A follow-up effort made to an insurance company to locate the status of an insurance claim is called a/an
- A.
Inquiry
- B.
Tracer
- C.
Rebill
- D.
Both inquiry and tracer
- 8.If an insurance claim has been lost by the insurance carrier, the procedure(s) to follow is to
- A.
Ask if there is a backlog of claims at the insurance office
- B.
Submit a copy of the original claim
- C.
Verify the correct mailing address
- D.
All of the above
- 9.An insurance claim with an invalid prodecure code would be
- A.
Paid
- B.
Rejected
- C.
Suspended
- D.
Denied
- 10.What should you do if an insurance carrier requests information about another insurance carrier?
- A.
Provide the information
- B.
Call the patient and advise the patient to contact the insurance carrier with the requested information
- C.
The carrier should contact the other carrier and coordinate benefits
- D.
None of the above
- 11.An insurance claim with a bundled service would be
- A.
Paid
- B.
Rejected
- C.
Suspended
- D.
Denied
- 12.What should be done if an insurance claim denial is received because a billed service was not a program benefit?
- A.
Rebill with a letter of explanation from the physician
- B.
Write off the amount on the patient's ledger
- C.
Send the patient a statement with a notation of the response from the insurance company
- D.
Appeal the decision with a statement from the physician
- 13.What should be done if an insurance company denies a service stating it was not medically necessary and the physician believes it was?
- A.
Rebill with a letter of explanation from the physician
- B.
Write off the amount on the patient's ledger
- C.
Send the patient a statement with a notation of the response from the insurance company
- D.
Appeal the decision with a statement from the physician
- 14.When downcoding occurs, payment will
- A.
Not be affected
- B.
Be denied
- C.
Be less
- D.
Be more
- 15.If an insurance company admits that a patient signed an assignment of benefits document and that it inadvertently paid the patient instead of the physician, the insurance company should
- A.
Advise the physician to write off the amount as a bad debt
- B.
Pay the physician within 2 to 3 weeks and honor the assignment even before the company recovers their money from the patient
- C.
Pay the physician witin 2 to 3 weeks after recovering the money from the patient
- D.
Notify the physician of the error and indicate in a letter that it will never happen again
- 16.The total number of levels of redetermination that exist in the Medicare program is
- A.
Two
- B.
Three
- C.
Five
- D.
Six
- 17.The first level of appeal in the Medicare program is
- A.
Redetermination
- B.
Inquiry
- C.
Fair hearing
- D.
Appeals council review
- 18.The correct method to send documents for a Medicare reconsideration (Level 2) is by
- A.
Certified mail with return receipt requested
- B.
Certified mail
- C.
Standard mail
- D.
Overnight mail
- 19.A request for a Medicare administrative law judge hearing can be made if the amount in controversy is at least
- A.
$100
- B.
$250
- C.
$350
- D.
$500
- 20.How many levels of review exist for TRICARE appeal procedures?
- A.
One
- B.
Two
- C.
Three
- D.
Five
- 21.TRICARE appeals are normally resolved within
- A.
2 weeks
- B.
30 days
- C.
60 days
- D.
90 days
- 22.In a TRICARE case, a request for an independent hearing may be pursued if the amount in question is
- A.
$100 or more
- B.
$300 or more
- C.
$500 or more
- D.
$1000 or more
- 23.Cash flow is
- A.
The amount of money available in the cash drawer
- B.
The amount of money taken into the office in a given period of time
- C.
The ongoing availability of cash in the medical practice
- D.
The amount of money in accounts receivable
- 24.When insurance carriers do not pay claims in a timely manner, what effect does this have on the medical practice
- A.
Increased cash flow
- B.
Decreased cash flow
- C.
Decreased accounts receivable
- D.
Decreased copayments
- 25.What does the insurance billing specialist need to monitor to be able to evaluate the effectiveness of the collection process
- A.
Number of statements sent
- B.
Number of claims processed
- C.
Accounts payable
- D.
Accounts receivable
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