Question 1

Another term for prior authorization number is
A) referral waiver.
B) supplemental number.
C) certification number.
D) self-pay.

Accepted Answer

Prior authorization numbers are also known as certification numbers. They are used by insurance companies to indicate that a procedure or service has been approved in advance.

Question 2

A patient's insurance card usually shows
A) the name of the payer's representative.
B) the date the policyholder first paid a premium or copayment.
C) member identification number.
D) the former employer's name.

Accepted Answer

The member identification number is typically shown on a patient's insurance card to identify the policyholder's account with the insurance company.

Question 3

What must patients who are members of CDHPs do before their health plan makes a payment?
A) Self-bill their health plan.
B) Meet a large deductible.
C) Pay their coinsurance.
D) Allow the provider to accept assignment.

Accepted Answer

Patients who are members of Consumer-Directed Health Plans (CDHPs) must meet a large deductible before their health plan begins to make payments. This is a fundamental characteristic of CDHPs, designed to encourage consumers to make more informed and cost-effective healthcare decisions.

Question 4

Pick the type of use of PHI that a practice would employ to train their staff to improve the quality of their health care.
A) payment
B) patient information form
C) health care operations
D) treatment

Accepted Answer

Health care operations include activities such as quality assessment and improvement initiatives, training programs, and accreditation, certification, licensing, or credentialing activities. Training staff to improve the quality of health care falls under this category.

Question 5

What are the procedures that ensure billable services are recorded and reported for payment called?
A) documentation
B) communications
C) coordination of benefits
D) charge capture

Accepted Answer

Charge capture is the process used to ensure that all services provided by a healthcare facility are recorded and reported for the purpose of billing and payment. This includes capturing information about procedures, tests, and treatments provided to patients so that the facility can bill the appropriate payers or patients.

Question 6

Pick the type of use of PHI that a practice would employ to discuss a patient's case with another provider.
A) health care operations
B) patient information form
C) payment
D) treatment

Accepted Answer

Discussing a patient's case with another provider for the purpose of coordinating care falls under the category of "treatment" in the context of PHI (Protected Health Information) use.

Question 7

The first health plan to pay when more than one plan is in effect is called the
A) secondary insurance.
B) primary insurance.
C) supplemental insurance.
D) tertiary insurance.

Accepted Answer

The primary insurance is the first health plan to pay when more than one plan is in effect, covering healthcare costs before any other insurance is billed.

Question 8

Sometimes the use of a third payer is necessary after two health plans have made payments on a claim. This type of insurance is known as
A) secondary insurance.
B) supplemental insurance.
C) primary insurance.
D) tertiary insurance.

Accepted Answer

Tertiary insurance comes into play after primary and secondary insurances have already made payments on a claim, covering additional costs that the first two policies did not cover.

Question 9

Identify the factor that does not determine a patient's copayment.
A) whether the provider is in the patient's network
B) the type of service
C) the length of time the patient has been seeing the practice
D) none of these

Accepted Answer

The length of time a patient has been seeing the practice typically does not determine a patient's copayment. Copayments are usually influenced by factors such as whether the provider is in the patient's network and the type of service provided, rather than the duration of the patient-provider relationship.

Question 10

For assigned claims, the payment for services rendered is expected
A) after the patient receives a statement.
B) when the claim is sent.
C) at the time of service.
D) after the insurance is billed.

Accepted Answer

The answer of For assigned claims, the payment for services...

Quiz 3: Patient Encounters and Billing Information

Another term for prior authorization number is

A patient's insurance card usually shows

What must patients who are members of CDHPs do before their health plan makes a payment?

Pick the type of use of PHI that a practice would employ to train their staff to improve the quality of their health care.

What are the procedures that ensure billable services are recorded and reported for payment called?

Pick the type of use of PHI that a practice would employ to discuss a patient's case with another provider.

The first health plan to pay when more than one plan is in effect is called the

Sometimes the use of a third payer is necessary after two health plans have made payments on a claim. This type of insurance is known as

Identify the factor that does not determine a patient's copayment.

For assigned claims, the payment for services rendered is expected