Question 1

Prompt-pay laws govern

Accepted Answer

A)   physicians to pay pharmacies for medications.
B)   patients to pay physicians for services.
C)   physician practice payments of their suppliers' invoices.
D)   insurance carriers' payments of providers' claims.

Question 2

If Medicare is the secondary payer, the claim must be submitted using the

Accepted Answer

A)   HIPAA 276/277.
B)   HIPAA 837P.
C)   HIPAA 835.
D)   CMS-1800.

Question 3

The __________ is the person or entity who seeks to receive benefits via an appeal.

Accepted Answer

A)   claimant
B)   defendant
C)   attorney
D)   plaintiff

Question 4

What may result from a lack of clear, correct linkage between the diagnosis and the procedure?

Accepted Answer

A)   initial processing
B)   medical necessity denial
C)   redetermination
D)   manual review

Question 5

An insurance aging report lists

Accepted Answer

A)   amounts patients still owe the physician.
B)   unpaid claims transmitted to payers by the length of time they remain due.
C)   the practice's patients, their insurance information, and their ages.
D)   the amount of supplies the practice needs to pay for.

Question 6

A paper explanation of benefits (EOB)  is sent to patients by payers after claims

Accepted Answer

A)   are submitted.
B)   are adjudicated.
C)   are paid.
D)   are denied.

Question 7

In the appeals process, calendar days are considered

Accepted Answer

A)   all days, including weekends.
B)   Saturday and Sunday.
C)   work days only.
D)   Monday-Thursday.

Question 8

Which of the following is an example of concurrent care?

Accepted Answer

A)   a case in which a patient is seen in the emergency room and then admitted by a different doctor to the floor
B)   a case in which a patient is attended by two physicians, such as a cardiologist and a thoracic surgeon, during surgery
C)   a case in which a patient is seen in the emergency room and transferred across town to a different facility
D)   a case in which a nurse practitioner sees the patient and then transfers the care to a physician

Question 9

A typical aging report groups payments that are due into which of these categories?

Accepted Answer

A)   0-30 days, 31-60 days, 61-90 days, 91-120 days, and over 121 days
B)   0-60 days, 61-120 days, 121-180 days, over 180 days
C)   0-15 days, 16-30 days, 31-45 days, 45-60 days
D)   0-45 days, 46-90 days, 91-135 days, over 135 days A

Question 10

RAs generally have information on any

Accepted Answer

A)   errors on the listed claims.
B)   all of these are correct.
C)   adjustments to the listed claims.
D)   denials to the listed claims.

Question 11

RA is the abbreviation for

Accepted Answer

A)   remittance advice.
B)   results advice.
C)   remittance allowed.
D)   results allowed.

Question 12

Claim adjustment reason codes are found on

Accepted Answer

A)   the insurance aging report.
B)   RAs.
C)   accounts receivable reports.
D)   the patient medical record. B

Question 13

A payer's decision regarding whether to pay, deny, or partially pay a claim is called

Accepted Answer

A)   evaluation.
B)   determination.
C)   utilization.
D)   adjudication.

Question 14

The payer sends the medical practice

Accepted Answer

A)   a separate RA and an individual EOB for each claim processed.
B)   only an RA upon request.
C)   a separate RA for each processed claim.
D)   an RA that covers a batch of processed claims.

Question 15

How often are claim adjustment reason codes and remark codes updated?

Accepted Answer

A)   annually
B)   three times per year
C)   quarterly
D)   never

Question 16

The __________ verifies the medical necessity of providers' reported procedures.

Accepted Answer

A)   claims processor
B)   physician
C)   claims examiner
D)   auditor

Question 17

A Medicare Redetermination Notice explains

Accepted Answer

A)   Medicare's unfavorable or partially favorable response to a request for redetermination.
B)   Medicare's positive response to a request for redetermination.
C)   Medicare's fines imposed after an audit.
D)   Medicare's findings after an audit.

Question 18

What does the abbreviation COB stand for?

Accepted Answer

A)   Coordination of billing
B)   Coordination of benefits
C)   Cooperation of billing
D)   Cooperation of benefits

Question 19

When is an appeal sent to third-party payers?

Accepted Answer

A)   before a questionable claim is transmitted
B)   after a claim is rejected or paid at less than the expected amount
C)   after a claim is submitted
D)   after a claim is paid B

Question 20

__________ is a feature of some medical billing programs that automatically records payments in the correct accounts.

Accepted Answer

A)   Autoposting
B)   Determination
C)   EFT
D)   Reconciliation

Exam 13: Payments Ras, Appeals, and Secondary Claims

Prompt-pay laws govern

Correct AnswerverifiedShow Answer

If Medicare is the secondary payer, the claim must be submitted using the

Correct AnswerverifiedShow Answer

The __________ is the person or entity who seeks to receive benefits via an appeal.

Correct AnswerverifiedShow Answer

What may result from a lack of clear, correct linkage between the diagnosis and the procedure?

Correct AnswerverifiedShow Answer

An insurance aging report lists

Correct AnswerverifiedShow Answer

A paper explanation of benefits (EOB) is sent to patients by payers after claims

Correct AnswerverifiedShow Answer

In the appeals process, calendar days are considered

Correct AnswerverifiedShow Answer

Which of the following is an example of concurrent care?

Correct AnswerverifiedShow Answer

A typical aging report groups payments that are due into which of these categories?

Correct AnswerverifiedA

RAs generally have information on any

Correct AnswerverifiedShow Answer

RA is the abbreviation for

Correct AnswerverifiedShow Answer

Claim adjustment reason codes are found on

Correct AnswerverifiedB

A payer's decision regarding whether to pay, deny, or partially pay a claim is called

Correct AnswerverifiedShow Answer

The payer sends the medical practice

Correct AnswerverifiedShow Answer

How often are claim adjustment reason codes and remark codes updated?

Correct AnswerverifiedShow Answer

The __________ verifies the medical necessity of providers' reported procedures.

Correct AnswerverifiedShow Answer

A Medicare Redetermination Notice explains

Correct AnswerverifiedShow Answer

What does the abbreviation COB stand for?

Correct AnswerverifiedShow Answer

When is an appeal sent to third-party payers?

Correct AnswerverifiedB

__________ is a feature of some medical billing programs that automatically records payments in the correct accounts.

Correct AnswerverifiedShow Answer

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A

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B

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B

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