Healthcare Quiz 1

What are the 2 types of Services?

• Inpatient & Outpatient

• New patient & Established patient

• Normal and emergency service

A patient fell off the roof while connecting the cable wires to a client during duty. He has BCBS as primary, Medicare as secondary. And Sedgwick as workers comp. Who will be responsible for the claim?

• Blue Cross

• Sedgwick

• Medicare

A patient's claim got denied for "Non covered service under the patient's plan''. Who do you think is responsible in checking this information?

• Coding

• Claim generation & submission

• Eligibility & benefit verification

What is the term for the process of obtaining approval from an insurance company before providing medical services?

• Pre-authorization

• Pre-certification

• Benefit verification

A patient that has a PPO plan, went out of town for a business trip, he then got sick and had to go and see a doctor, this is the first time that he will see this doctor . He is considered as

• As an exclusive

• As a new patient

• As an established patient.

Insurance denied the claim showing that the CPT codes are wrong. The error happened while Entering charges. Which step of RCM is responsible for this error?

• Charge Capture / Charge Entry

• Coding

• Claim generation & submission

If a patient has an HMO plan, what does he need from his doctor so that he can see a specialist?

• Authorization

• Claim number

• Referral

What is a document supplied by the insurance to the Provider/Billing Office that provides notice and explanation of reasons for payments.

• Explanation of Benefits

• Electronic Remittance Advice

• Assignment of Benefits

The patient was treated in a Rehab Center. After meeting his yearly deductible his Insurance Plan decided to pay 80% and billed him for 20% of the allowed charges. Amount billed to the patient is his?

• US holiday discount

• Co-Insurance

• Copay

The process of reviewing medical records to ensure accurate coding and billing?

• Charge Capture

• Coding

• Claim generation & submission