MA139 - Feb 2020

A ________ is the documentation submitted to a third-party payer or government program requesting reimbursement for health care services provided.

Group of answer choices

• medical record

• patient ledger

• health insurance claim

• NSF check

The process of reporting ________ as numeric and alphanumeric characters on the insurance claim is called coding.

• dates of service for procedures

• diagnoses and procedures/services

• health insurance claims identifiers

• national provider identifiers

A claims examiner employed by a third-party payer reviews health-related claims to determine whether the charges are reasonable, in addition to ________.

• assigning ICD-10-CM and CPT codes

• billing patients for copayments and coinsurance

• determining medical necessity of services/procedures

• resubmitting denied claims to health care providers

Which does a provider usually employ to perform administrative and clinical tasks, which help keep the office or clinic running smoothly?

• Health information technicians

• Medical assistants

• Nurse practitioners

• Reimbursement specialists

Health information technicians ________.

• assist with direct patient care

• document clinical information

• manage medical records

• process health insurance claims

When a health insurance plan's preauthorization requirements are not met by providers, ________.

• administrative costs are reduced

• patients' coverage is canceled

• payment of the claim is denied

• providers pay a fine to the plan

Which of the following includes the identification of disease and the provision of care and treatment to persons who are sick, injured, or concerned about their health status?

• Health insurance

• Medical care

• Preventive care

• Third-party payment

Which is the amount for which the patient is financially responsible before an insurance policy provides payment?

• Coinsurance

• Copayment

• Deductible

• Exclusionary

Medicare requires providers to submit the ________ claim for payment of outpatient and office services.

• CMS-1450

• CMS-1500

• UB-02

• UB-04

A healthcare practitioner is also called a ________.

• dealer

• provider

• purveyor

• supplier