Test Bank Understanding Health Insurance: A Guide to Billing and Reimbursement, 2026 Edition 21e Green
Chapter 01 - Health Insurance Specialist Career
1. If the insurance plan has a hold harmless clause, it means that the patient:
a. is charged for fees by the health care provider, per the EOB.
b. automatically has lower out-of-pocket health care expenses.
c. is not responsible for paying what the insurance plan denies.
d. is required to pay any amounts that the insurance plan denies.
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.1 - Briefly summarize health insurance claims processing and the parties involved.
DATE CREATED: 12/17/2025 7:09 AM
DATE MODIFIED: 12/17/2025 11:42 PM
2. The process of assigning diagnoses and procedures/services as numeric and alphanumeric characters on the insurance
claim is called _____.
a. transcribing
b. coding
c. reporting
d. auditing
ANSWER: b
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.1 - Briefly summarize health insurance claims processing and the parties involved.
DATE CREATED: 12/17/2025 7:09 AM
DATE MODIFIED: 12/17/2025 11:42 PM
3. A claims examiner reviews health-related claims to determine whether the charges are reasonable, in addition to:
a. assigning ICD-10-CM and CPT codes.
b. billing patients for copayments and coinsurance.
c. determining the medical necessity of services/procedures.
d. resubmitting denied claims to health care providers.
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.1 - Briefly summarize health insurance claims processing and the parties involved.
1.2 - Identify career opportunities available for health insurance specialists.
DATE CREATED: 12/17/2025 7:09 AM
DATE MODIFIED: 12/18/2025 2:16 AM
4. Which is another name for a health insurance specialist?
a. Billing specialist
Page 1
,Name: Class: Date:
Chapter 01 - Health Insurance Specialist Career
b. Coding specialist
c. Health information specialist
d. Reimbursement specialist
ANSWER: d
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.2 - Identify career opportunities available for health insurance specialists.
DATE CREATED: 12/17/2025 7:09 AM
DATE MODIFIED: 12/17/2025 11:42 PM
5. A claims examiner is employed by a:
a. facility to submit claims.
b. governmental agency to process claims.
c. physician’s office to submit claims.
d. third-party payer to review claims.
ANSWER: d
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.2 - Identify career opportunities available for health insurance specialists.
DATE CREATED: 12/17/2025 7:09 AM
DATE MODIFIED: 12/17/2025 11:42 PM
6. Which involves linking every procedure or service code reported on the claim to a condition code that justifies the
reason for performing that procedure or service?
a. Claims adjudication
b. Diagnosis coding
c. Medical necessity
d. Reimbursement processing
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.1 - Briefly summarize health insurance claims processing and the parties involved.
DATE CREATED: 12/17/2025 7:09 AM
DATE MODIFIED: 12/17/2025 11:42 PM
7. The Current Procedural Terminology (CPT) manual is published by the:
a. American Billing Association.
b. American Board of Physicians.
c. American Dental Association.
d. American Medical Association.
Page 2
,Name: Class: Date:
Chapter 01 - Health Insurance Specialist Career
ANSWER: d
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.1 - Briefly summarize health insurance claims processing and the parties involved.
DATE CREATED: 12/17/2025 7:09 AM
DATE MODIFIED: 12/17/2025 11:42 PM
8. Which of these is submitted to the payer requesting reimbursement?
a. Explanation of benefits
b. Health insurance claim
c. Remittance advice
d. Prior approval form
ANSWER: b
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.1 - Briefly summarize health insurance claims processing and the parties involved.
DATE CREATED: 12/17/2025 7:09 AM
DATE MODIFIED: 12/17/2025 11:42 PM
9. The Centers for Medicare & Medicaid Services (CMS) is the administrative agency within the _____.
a. ACF
b. DHHS
c. FDA
d. OIG
ANSWER: b
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.1 - Briefly summarize health insurance claims processing and the parties involved.
DATE CREATED: 12/17/2025 7:09 AM
DATE MODIFIED: 12/17/2025 11:42 PM
10. Payment of a health insurance plan’s claim is denied if:
a. the patient misses their scheduled appointment.
b. the provider fails to verify the patient’s coverage or benefit eligibility.
c. prior approval requirements are not met by providers.
d. the patient receives preventive services.
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
Page 3
, Name: Class: Date:
Chapter 01 - Health Insurance Specialist Career
LEARNING OBJECTIVES: 1.1 - Briefly summarize health insurance claims processing and the parties involved.
DATE CREATED: 12/17/2025 7:09 AM
DATE MODIFIED: 12/17/2025 11:42 PM
11. Which coding system is used to report outpatient procedures and services on claims?
a. CPT
b. ICD-10-CM
c. HCPCS Level II
d. ICD-10-PCS
ANSWER: a
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.1 - Briefly summarize health insurance claims processing and the parties involved.
DATE CREATED: 12/17/2025 7:09 AM
DATE MODIFIED: 12/17/2025 11:42 PM
12. Which would be found on a remittance advice?
a. Detected errors and omissions from claims
b. Documentation of medical necessity
c. Payment information about a claim
d. Patient eligibility or coverage details
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.4 - Describe the job responsibilities of a health insurance specialist.
DATE CREATED: 12/17/2025 7:09 AM
DATE MODIFIED: 12/17/2025 11:42 PM
13. Which guarantees repayment for financial losses resulting from an employee’s act or failure to act?
a. Bonding insurance
b. Liability insurance
c. Property insurance
d. Workers’ compensation insurance
ANSWER: a
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.5 - Differentiate among types of liability insurance purchased by employers and
independent contractors.
DATE CREATED: 12/17/2025 7:09 AM
DATE MODIFIED: 12/17/2025 11:42 PM
Page 4
Chapter 01 - Health Insurance Specialist Career
1. If the insurance plan has a hold harmless clause, it means that the patient:
a. is charged for fees by the health care provider, per the EOB.
b. automatically has lower out-of-pocket health care expenses.
c. is not responsible for paying what the insurance plan denies.
d. is required to pay any amounts that the insurance plan denies.
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.1 - Briefly summarize health insurance claims processing and the parties involved.
DATE CREATED: 12/17/2025 7:09 AM
DATE MODIFIED: 12/17/2025 11:42 PM
2. The process of assigning diagnoses and procedures/services as numeric and alphanumeric characters on the insurance
claim is called _____.
a. transcribing
b. coding
c. reporting
d. auditing
ANSWER: b
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.1 - Briefly summarize health insurance claims processing and the parties involved.
DATE CREATED: 12/17/2025 7:09 AM
DATE MODIFIED: 12/17/2025 11:42 PM
3. A claims examiner reviews health-related claims to determine whether the charges are reasonable, in addition to:
a. assigning ICD-10-CM and CPT codes.
b. billing patients for copayments and coinsurance.
c. determining the medical necessity of services/procedures.
d. resubmitting denied claims to health care providers.
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.1 - Briefly summarize health insurance claims processing and the parties involved.
1.2 - Identify career opportunities available for health insurance specialists.
DATE CREATED: 12/17/2025 7:09 AM
DATE MODIFIED: 12/18/2025 2:16 AM
4. Which is another name for a health insurance specialist?
a. Billing specialist
Page 1
,Name: Class: Date:
Chapter 01 - Health Insurance Specialist Career
b. Coding specialist
c. Health information specialist
d. Reimbursement specialist
ANSWER: d
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.2 - Identify career opportunities available for health insurance specialists.
DATE CREATED: 12/17/2025 7:09 AM
DATE MODIFIED: 12/17/2025 11:42 PM
5. A claims examiner is employed by a:
a. facility to submit claims.
b. governmental agency to process claims.
c. physician’s office to submit claims.
d. third-party payer to review claims.
ANSWER: d
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.2 - Identify career opportunities available for health insurance specialists.
DATE CREATED: 12/17/2025 7:09 AM
DATE MODIFIED: 12/17/2025 11:42 PM
6. Which involves linking every procedure or service code reported on the claim to a condition code that justifies the
reason for performing that procedure or service?
a. Claims adjudication
b. Diagnosis coding
c. Medical necessity
d. Reimbursement processing
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.1 - Briefly summarize health insurance claims processing and the parties involved.
DATE CREATED: 12/17/2025 7:09 AM
DATE MODIFIED: 12/17/2025 11:42 PM
7. The Current Procedural Terminology (CPT) manual is published by the:
a. American Billing Association.
b. American Board of Physicians.
c. American Dental Association.
d. American Medical Association.
Page 2
,Name: Class: Date:
Chapter 01 - Health Insurance Specialist Career
ANSWER: d
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.1 - Briefly summarize health insurance claims processing and the parties involved.
DATE CREATED: 12/17/2025 7:09 AM
DATE MODIFIED: 12/17/2025 11:42 PM
8. Which of these is submitted to the payer requesting reimbursement?
a. Explanation of benefits
b. Health insurance claim
c. Remittance advice
d. Prior approval form
ANSWER: b
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.1 - Briefly summarize health insurance claims processing and the parties involved.
DATE CREATED: 12/17/2025 7:09 AM
DATE MODIFIED: 12/17/2025 11:42 PM
9. The Centers for Medicare & Medicaid Services (CMS) is the administrative agency within the _____.
a. ACF
b. DHHS
c. FDA
d. OIG
ANSWER: b
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.1 - Briefly summarize health insurance claims processing and the parties involved.
DATE CREATED: 12/17/2025 7:09 AM
DATE MODIFIED: 12/17/2025 11:42 PM
10. Payment of a health insurance plan’s claim is denied if:
a. the patient misses their scheduled appointment.
b. the provider fails to verify the patient’s coverage or benefit eligibility.
c. prior approval requirements are not met by providers.
d. the patient receives preventive services.
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
Page 3
, Name: Class: Date:
Chapter 01 - Health Insurance Specialist Career
LEARNING OBJECTIVES: 1.1 - Briefly summarize health insurance claims processing and the parties involved.
DATE CREATED: 12/17/2025 7:09 AM
DATE MODIFIED: 12/17/2025 11:42 PM
11. Which coding system is used to report outpatient procedures and services on claims?
a. CPT
b. ICD-10-CM
c. HCPCS Level II
d. ICD-10-PCS
ANSWER: a
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.1 - Briefly summarize health insurance claims processing and the parties involved.
DATE CREATED: 12/17/2025 7:09 AM
DATE MODIFIED: 12/17/2025 11:42 PM
12. Which would be found on a remittance advice?
a. Detected errors and omissions from claims
b. Documentation of medical necessity
c. Payment information about a claim
d. Patient eligibility or coverage details
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.4 - Describe the job responsibilities of a health insurance specialist.
DATE CREATED: 12/17/2025 7:09 AM
DATE MODIFIED: 12/17/2025 11:42 PM
13. Which guarantees repayment for financial losses resulting from an employee’s act or failure to act?
a. Bonding insurance
b. Liability insurance
c. Property insurance
d. Workers’ compensation insurance
ANSWER: a
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: 1.5 - Differentiate among types of liability insurance purchased by employers and
independent contractors.
DATE CREATED: 12/17/2025 7:09 AM
DATE MODIFIED: 12/17/2025 11:42 PM
Page 4
