Module 113 Final Review

82 Questions | Total Attempts: 118

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Module Quizzes & Trivia

Questions and Answers
  • 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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