Question 1

​Match the type of insurance to its description.Note: Answers may be used more than once.
-​All of the providers in the network are required to file a claim to get paid

Accepted Answer

HMO (Health Maintenance Organization) plans require all providers in their network to file a claim to get paid. This is part of their managed care structure, where services are provided within a network of healthcare providers to manage costs and ensure quality.

Question 2

​The process of billing a secondary insurance company involves which of the following?

Accepted Answer

The process of billing a secondary insurance involves waiting until the primary insurance has made its payment, then either creating a new bill with the secondary insurance information or electronically submitting the claim to the secondary insurer. This ensures that the secondary insurance is only billed for amounts not covered by the primary insurance.

Question 3

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once.
-​Payment is quicker,claims usually received by a payer within 24 hours

Accepted Answer

Electronic claims tracking allows for faster processing and payment, with claims often being received by the payer within 24 hours.

Question 4

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once.
-​Claims can be entered from anywhere with Internet access with real-time response

Accepted Answer

Electronic claims tracking allows for claims to be entered from anywhere with Internet access, providing real-time responses, which is not characteristic of manual claims tracking.

Question 5

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once.
-​Office cost is reduced by eliminating the need for stamps,forms,and excess office staff labor

Accepted Answer

Electronic claims tracking reduces office costs by eliminating the need for physical materials like stamps and forms, and reduces the labor required for processing, making the process more efficient and cost-effective.

Question 6

​Which of the following is not considered a true statement regarding the history of claims?

Accepted Answer

Providers have historically been paid using various methods, including the exchange of services or bartering of goods, especially before the modern insurance and monetary systems were fully developed.

Question 7

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once.
-​A time-consuming process that frequently causes payment delays

Accepted Answer

Manual claims tracking is often considered time-consuming and can lead to payment delays due to the need for physical handling and processing of paperwork.

Question 8

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once.
-​Have a "claim scrubber" program that will scrub the claim before it is sent to payers

Accepted Answer

The use of a "claim scrubber" program, which reviews and cleans up claims before they are sent to payers, is a feature of electronic claims tracking systems. This technology automates the process, making it specific to electronic, not manual, claims tracking.

Question 9

​Match the type of insurance to its description.Note: Answers may be used more than once.
-​A group insurance that entitles members to services provided by participating hospitals,clinics,and providers

Accepted Answer

HMO (Health Maintenance Organization) plans provide a network of healthcare providers for members to use, typically requiring them to choose a primary care physician and get referrals for specialists, which matches the description given.

Question 10

​Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once.
-​When a person or company knowingly deceives Medicare as an intentional act to receive inappropriate payment from the program

Accepted Answer

Fraud involves intentional deception or misrepresentation that someone makes, knowing it is false, and that could result in unauthorized payment from the Medicare program.

Question 11

​Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once.
-​With intent

Accepted Answer

Fraud involves intentional deception or misrepresentation that someone makes, knowing it could result in some unauthorized benefit to themselves or some other person. It is distinguished from abuse by the element of intent.

Question 12

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once.
-​Payers typically do not inform providers of the status of their claims

Accepted Answer

In manual claims tracking, payers typically do not inform providers of the status of their claims, requiring providers to follow up independently to check on claim status.

Question 13

​A private or public company that often serves as the middleman between providers and billing groups,payers,and other health care partners for the transmission and translation of electronic claims information into the specific format required by payers is known as:

Accepted Answer

A clearinghouse in the healthcare industry acts as an intermediary that processes and translates claims information from healthcare providers into the specific format required by payers (insurance companies), ensuring that the claims meet the necessary standards and regulations for payment.

Question 14

​Which of the following is not a common claim error?

Accepted Answer

Using correct ICD codes or ICD codes that support the CPT codes is not an error; it is actually the correct practice for medical billing.

Question 15

​Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once.
-​When providers seek Medicare payment they do not deserve but have not knowingly or intentionally done so

Accepted Answer

Abuse involves practices that may indirectly lead to unnecessary costs to Medicare but do not involve intentional misrepresentation. Seeking payment for services not deserved, without the intent to deceive, falls under abuse.

Question 16

​Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once.
-​Without intent

Accepted Answer

Abuse in the context of Medicare claims refers to practices that may indirectly result in unnecessary costs to the Medicare program but do not involve intentional misrepresentation. Without intent to deceive or misrepresent, the action falls under abuse rather than fraud.

Question 17

​Which of the following is not one of the necessary pieces of information to have before calling to follow up on a delinquent insurance claim?

Accepted Answer

The amount of copay received from the patient is not necessary for following up on a delinquent insurance claim. The other information is needed to identify the claim and the insured party.

Question 18

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once.
-​Requires office collection staff to perform the extra task of making phone calls to key payers to determine whether claims are being processed

Accepted Answer

Manual claims tracking often involves additional tasks for office staff, such as making phone calls to payers to check on the status of claims processing, which is not typically required with electronic claims tracking systems.

Question 19

​Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once.
-​Billing for services,supplies,or equipment that were not medically necessary or not provided

Accepted Answer

Billing for services, supplies, or equipment that were not medically necessary or not provided is considered fraud because it involves intentionally submitting false claims to gain financial benefit.

Question 20

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once.
-​Results can be viewed easily on a computer screen and information printed as needed

Accepted Answer

Electronic claims tracking allows for easy viewing of results on a computer screen and the ability to print information as needed, aligning with the capabilities of digital systems.

Quiz 31: Preparing Insurance Claims and Posting Insurance Payments

Match the type of insurance to its description.Note: Answers may be used more than once. -All of the providers in the network are required to file a claim to get paid

The process of billing a secondary insurance company involves which of the following?

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -Payment is quicker,claims usually received by a payer within 24 hours

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -Claims can be entered from anywhere with Internet access with real-time response

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -Office cost is reduced by eliminating the need for stamps,forms,and excess office staff labor

Which of the following is not considered a true statement regarding the history of claims?

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -A time-consuming process that frequently causes payment delays

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -Have a "claim scrubber" program that will scrub the claim before it is sent to payers

Match the type of insurance to its description.Note: Answers may be used more than once. -A group insurance that entitles members to services provided by participating hospitals,clinics,and providers

Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once. -When a person or company knowingly deceives Medicare as an intentional act to receive inappropriate payment from the program

Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once. -With intent

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -Payers typically do not inform providers of the status of their claims

A private or public company that often serves as the middleman between providers and billing groups,payers,and other health care partners for the transmission and translation of electronic claims information into the specific format required by payers is known as:

Which of the following is not a common claim error?

Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once. -When providers seek Medicare payment they do not deserve but have not knowingly or intentionally done so

Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once. -Without intent

Which of the following is not one of the necessary pieces of information to have before calling to follow up on a delinquent insurance claim?

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -Requires office collection staff to perform the extra task of making phone calls to key payers to determine whether claims are being processed

Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once. -Billing for services,supplies,or equipment that were not medically necessary or not provided

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -Results can be viewed easily on a computer screen and information printed as needed

Quiz 31: Preparing Insurance Claims and Posting Insurance Payments

​Match the type of insurance to its description.Note: Answers may be used more than once. -​All of the providers in the network are required to file a claim to get paid

​The process of billing a secondary insurance company involves which of the following?

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -​Payment is quicker,claims usually received by a payer within 24 hours

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -​Claims can be entered from anywhere with Internet access with real-time response

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -​Office cost is reduced by eliminating the need for stamps,forms,and excess office staff labor

​Which of the following is not considered a true statement regarding the history of claims?

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -​A time-consuming process that frequently causes payment delays

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -​Have a "claim scrubber" program that will scrub the claim before it is sent to payers

​Match the type of insurance to its description.Note: Answers may be used more than once. -​A group insurance that entitles members to services provided by participating hospitals,clinics,and providers

​Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once. -​When a person or company knowingly deceives Medicare as an intentional act to receive inappropriate payment from the program

​Match the definition/scenario to differentiate between fraud and abuse relating to Medicare claims.Note: Answers may be used more than once. -​With intent

Match the following definition of claims tracking to "Manual" or "Electronic." Note: answers may be used more than once. -​Payers typically do not inform providers of the status of their claims