Complete Chapters Solutions Included ✅
MOSS Answer Key Included
Solution and Answer Guide: Michelle A. Green, Understanding Health Insurance: A Guide to Billing and
Reimbursement: 2026, 21st Edition, 9798214482088; Chapter 1: Health Insurance Specialist Career
Solution and Answer Guide
MICHELLE A. GREEN, UNDERSTANDING HEALTH INSURANCE: A GUIDE TO BILLING AND
REIMBURSEMENT: 2026, 21ST EDITION, 9798214482088; CHAPTER 1: HEALTH INSURANCE
SPECIALIST CAREER
TABLE OF CONTENTS
Review .................................................................................................................................... 1
1.1: Multiple Choice ....................................................................................................................... 1
1.2: Professionalism ..................................................................................................................... 8
REVIEW
1.1: MULTIPLE CHOICE
1. The document submitted to the payer requesting reimbursement is called a(n)
a. explanation of benefits.
b. health insurance claim.
c. remittance advice.
d. prior approval form.
ANS: b
Analysis:
a. Incorrect. The patient receives an explanation of benefits (EOB) from the third-party
payer, which is a report detailing the results of processing a claim. A health
insurance claim is the documentation submitted to a third-party payer or
government program requesting reimbursement for the health care services
provided.
b. Correct. A health insurance claim is the documentation submitted to a third-party
payer or government program requesting reimbursement for the health care
services provided.
c. Incorrect. The provider receives a remittance advice (or remit), a notice sent by the
insurance company that contains payment information about a claim. A health
insurance claim is the documentation submitted to a third-party payer or government
program requesting reimbursement for the health care services provided.
d. Incorrect. Many health insurance plans and programs require prior approval for
treatment by specialists and documentation of post-treatment reports, and if the
prior approval form is not submitted prior to treatment, payment of the claim is
denied. A health insurance claim is the documentation submitted to a third-party
payer or government program requesting reimbursement for the health care services
provided.
© 2026 1
i
, Solution and Answer Guide: Michelle A. Green, Understanding Health Insurance: A Guide to Billing and
Reimbursement: 2026, 21st Edition, 9798214482088; Chapter 1: Health Insurance Specialist Career
2. The Centers for Medicare & Medicaid Services (CMS) is an administrative agency within
the
a. Administration for Children and Families.
b. Department of Health and Human Services.
c. Food and Drug Administration.
d. Office of the Inspector General.
ANS: b
Analysis:
a. Incorrect. The Administration for Children and Families is an administrative agency of
the Department of Health and Human Services. The Centers for Medicare & Medicaid
Services is an administrative agency of the Department of Health and Human Services.
b. Correct. The Centers for Medicare & Medicaid Services is an administrative agency
of the Department of Health and Human Services.
c. Incorrect. The Food and Drug Administration is an administrative agency of the
Department of Health and Human Services. The Centers for Medicare & Medicaid
Services is an administrative agency of the Department of Health and Human
Services.
d. Incorrect. The Office of the Inspector General for the Department of Health and
Human Services reports to the Secretary of the Department of Health and Human
Services and the United States Congress. The Centers for Medicare & Medicaid
Services is an administrative agency of the Department of Health and Human
Services.
3. A health care practitioner is also called a health care
a. dealer.
b. provider.
c. purveyor.
d. supplier.
ANS: b
Analysis:
a. Incorrect. A health care dealer is an entity that purchases goods for wholesale or
retail re-selling, such as durable medical equipment. A health care provider is a
health care practitioner, such as a physician, physician’s assistance, or nurse
practitioner.
b. Correct. A health care provider is a health care practitioner, such as a physician,
physician’s assistance, or nurse practitioner.
c. Incorrect. A health care purveyor refers to an entity that sells or deals in a
particular type of goods. A health care provider is a health care practitioner, such
as a physician, physician’s assistance, or nurse practitioner.
d. Incorrect. A health care supplier is a person or organization that sells or supplies
goods, such as durable medical equipment. A health care provider is a health care
practitioner, such as a physician, physician’s assistance, or nurse practitioner.
© 2026 2
i
, Solution and Answer Guide: Michelle A. Green, Understanding Health Insurance: A Guide to Billing and
Reimbursement: 2026, 21st Edition, 9798214482088; Chapter 1: Health Insurance Specialist Career
4. Which is the most appropriate response to a patient who calls the office and asks to
speak with the physician?
a. Politely state that the physician is busy and cannot be disturbed.
b. Explain that the physician is unavailable and ask if the patient would like to leave a
message.
c. Transfer the call to the exam room where the physician is located.
d. Offer to schedule an appointment for the patient to be seen by the physician.
ANS: b
Analysis:
a. Incorrect. Office personnel should not state that the physician is busy and cannot be
disturbed. Office personnel should simply state that the physician is not available and
offer to take a message that will be passed along to the physician when available.
b. Correct. Office personnel should simply state that the physician is not available and
offer to take a message that will be passed along to the physician when available.
c. Incorrect. Unless the physician has specifically requested that a particular patient’s
call be forwarded to the exam room, the patient’s call should be addressed by office
personnel. Office personnel should simply state that the physician is not available and
offer to take a message that will be passed along to the physician when available.
d. Incorrect. The patient may only wish to speak to the physician; however, in many
cases, the patient’s issue may be addressed by the physician or other medical staff
(e.g., nurse practitioner, physician assistant) without the need for a patient
appointment. Office personnel should simply state that the physician is not available
and offer to take a message that will be passed along to the physician when available.
5. The process of assigning numeric and alphanumeric characters to diagnoses, procedures,
and services for claims reporting is called
a. coding.
b. data processing.
c. programming.
d. reimbursement.
ANS: a
Analysis:
a. Correct. The process of assigning numeric and alphanumeric characters to diagnoses,
procedures, and services for claims reporting is called coding.
b. Incorrect. Data processing is the collection and manipulation of data to produce
meaningful information. The process of assigning numeric and alphanumeric characters
to diagnoses, procedures, and services for claims reporting is called coding.
c. Incorrect. Programming is the process of creating executable computer software
programs that instruct the computer to perform specific tasks. The process of
assigning numeric and alphanumeric characters to diagnoses, procedures, and services
for claims reporting is called coding.
d. Incorrect. Reimbursement is the payment a provider receives for performing procedures
and providing services or supplies. The process of assigning numeric and alphanumeric
characters to diagnoses, procedures, and services for claims reporting is called coding.
© 2026 3
i
, Solution and Answer Guide: Michelle A. Green, Understanding Health Insurance: A Guide to Billing and
Reimbursement: 2026, 21st Edition, 9798214482088; Chapter 1: Health Insurance Specialist Career
6. If a health insurance plan’s prior approval requirements are not met by providers and
the claim is submitted for reimbursement,
a. administrative costs are reduced.
b. patients’ coverage is cancelled.
c. payment of the claim is denied.
d. they pay a fine to the health plan.
ANS: c
Analysis:
a. Incorrect. Administrative costs actually increase as a result of billing the patient
for services provided, submitting the bill to collections, and writing off the billed
amount. If a health insurance plan’s prior approval requirements are not met by
providers and the claim is submitted for reimbursement, the third-party payer
issues claims denials.
b. Incorrect. The patient’s coverage is not cancelled when prior approval requirements
are not met, but the payer may deny the claim. If a health insurance plan’s prior
approval requirements are not met by providers and the claim is submitted for
reimbursement, the third-party payer issues claims denials.
c. Correct. If a health insurance plan’s prior approval requirements are not met by
providers and the claim is submitted for reimbursement, the third-party payer
issues claims denials.
d. Incorrect. Providers and patients do not pay a fine to the health plan when prior
approval requirements are not met. If a health insurance plan’s prior approval
requirements are not met by providers and the claim is submitted for
reimbursement, the third-party payer issues claims denials.
7. Which coding system is used to report diagnoses and conditions on claims?
a. CPT
b. HCPCS Level II
c. ICD-10-CM
d. ICD-10-PCS
ANS: c
Analysis:
a. Incorrect. CPT, or Current Procedural Terminology, is used to report procedures or
services on outpatient and physician office claims. ICD-10-CM, or International
Classification of Diseases, 10th Revision, Clinical Modification, is used to report
diagnoses and conditions on all claims.
b. Incorrect. HCPCS Level II, or Healthcare Common Procedure Coding System Level II,
codes are used to report procedures or services on outpatient and physician office
claims, especially for medical devices, supplies, and drugs. ICD-10-CM, or International
Classification of Diseases, 10th Revision, Clinical Modification, is used to report
diagnoses and conditions on all claims.
c. Correct. ICD-10-CM, or International Classification of Diseases, 10th Revision,
Clinical Modification, is used to report diagnoses and conditions on all claims.
d. Incorrect. ICD-10-PCS, or International Classification of Diseases, 10th Revision,
Procedure Coding System, is used to report inpatient hospital procedures or services
on UB-04 claims. ICD-10-CM, or International Classification of Diseases, 10th Revision,
Clinical Modification, is used to report diagnoses and conditions on all claims.
© 2026 4
i
MOSS Answer Key Included
Solution and Answer Guide: Michelle A. Green, Understanding Health Insurance: A Guide to Billing and
Reimbursement: 2026, 21st Edition, 9798214482088; Chapter 1: Health Insurance Specialist Career
Solution and Answer Guide
MICHELLE A. GREEN, UNDERSTANDING HEALTH INSURANCE: A GUIDE TO BILLING AND
REIMBURSEMENT: 2026, 21ST EDITION, 9798214482088; CHAPTER 1: HEALTH INSURANCE
SPECIALIST CAREER
TABLE OF CONTENTS
Review .................................................................................................................................... 1
1.1: Multiple Choice ....................................................................................................................... 1
1.2: Professionalism ..................................................................................................................... 8
REVIEW
1.1: MULTIPLE CHOICE
1. The document submitted to the payer requesting reimbursement is called a(n)
a. explanation of benefits.
b. health insurance claim.
c. remittance advice.
d. prior approval form.
ANS: b
Analysis:
a. Incorrect. The patient receives an explanation of benefits (EOB) from the third-party
payer, which is a report detailing the results of processing a claim. A health
insurance claim is the documentation submitted to a third-party payer or
government program requesting reimbursement for the health care services
provided.
b. Correct. A health insurance claim is the documentation submitted to a third-party
payer or government program requesting reimbursement for the health care
services provided.
c. Incorrect. The provider receives a remittance advice (or remit), a notice sent by the
insurance company that contains payment information about a claim. A health
insurance claim is the documentation submitted to a third-party payer or government
program requesting reimbursement for the health care services provided.
d. Incorrect. Many health insurance plans and programs require prior approval for
treatment by specialists and documentation of post-treatment reports, and if the
prior approval form is not submitted prior to treatment, payment of the claim is
denied. A health insurance claim is the documentation submitted to a third-party
payer or government program requesting reimbursement for the health care services
provided.
© 2026 1
i
, Solution and Answer Guide: Michelle A. Green, Understanding Health Insurance: A Guide to Billing and
Reimbursement: 2026, 21st Edition, 9798214482088; Chapter 1: Health Insurance Specialist Career
2. The Centers for Medicare & Medicaid Services (CMS) is an administrative agency within
the
a. Administration for Children and Families.
b. Department of Health and Human Services.
c. Food and Drug Administration.
d. Office of the Inspector General.
ANS: b
Analysis:
a. Incorrect. The Administration for Children and Families is an administrative agency of
the Department of Health and Human Services. The Centers for Medicare & Medicaid
Services is an administrative agency of the Department of Health and Human Services.
b. Correct. The Centers for Medicare & Medicaid Services is an administrative agency
of the Department of Health and Human Services.
c. Incorrect. The Food and Drug Administration is an administrative agency of the
Department of Health and Human Services. The Centers for Medicare & Medicaid
Services is an administrative agency of the Department of Health and Human
Services.
d. Incorrect. The Office of the Inspector General for the Department of Health and
Human Services reports to the Secretary of the Department of Health and Human
Services and the United States Congress. The Centers for Medicare & Medicaid
Services is an administrative agency of the Department of Health and Human
Services.
3. A health care practitioner is also called a health care
a. dealer.
b. provider.
c. purveyor.
d. supplier.
ANS: b
Analysis:
a. Incorrect. A health care dealer is an entity that purchases goods for wholesale or
retail re-selling, such as durable medical equipment. A health care provider is a
health care practitioner, such as a physician, physician’s assistance, or nurse
practitioner.
b. Correct. A health care provider is a health care practitioner, such as a physician,
physician’s assistance, or nurse practitioner.
c. Incorrect. A health care purveyor refers to an entity that sells or deals in a
particular type of goods. A health care provider is a health care practitioner, such
as a physician, physician’s assistance, or nurse practitioner.
d. Incorrect. A health care supplier is a person or organization that sells or supplies
goods, such as durable medical equipment. A health care provider is a health care
practitioner, such as a physician, physician’s assistance, or nurse practitioner.
© 2026 2
i
, Solution and Answer Guide: Michelle A. Green, Understanding Health Insurance: A Guide to Billing and
Reimbursement: 2026, 21st Edition, 9798214482088; Chapter 1: Health Insurance Specialist Career
4. Which is the most appropriate response to a patient who calls the office and asks to
speak with the physician?
a. Politely state that the physician is busy and cannot be disturbed.
b. Explain that the physician is unavailable and ask if the patient would like to leave a
message.
c. Transfer the call to the exam room where the physician is located.
d. Offer to schedule an appointment for the patient to be seen by the physician.
ANS: b
Analysis:
a. Incorrect. Office personnel should not state that the physician is busy and cannot be
disturbed. Office personnel should simply state that the physician is not available and
offer to take a message that will be passed along to the physician when available.
b. Correct. Office personnel should simply state that the physician is not available and
offer to take a message that will be passed along to the physician when available.
c. Incorrect. Unless the physician has specifically requested that a particular patient’s
call be forwarded to the exam room, the patient’s call should be addressed by office
personnel. Office personnel should simply state that the physician is not available and
offer to take a message that will be passed along to the physician when available.
d. Incorrect. The patient may only wish to speak to the physician; however, in many
cases, the patient’s issue may be addressed by the physician or other medical staff
(e.g., nurse practitioner, physician assistant) without the need for a patient
appointment. Office personnel should simply state that the physician is not available
and offer to take a message that will be passed along to the physician when available.
5. The process of assigning numeric and alphanumeric characters to diagnoses, procedures,
and services for claims reporting is called
a. coding.
b. data processing.
c. programming.
d. reimbursement.
ANS: a
Analysis:
a. Correct. The process of assigning numeric and alphanumeric characters to diagnoses,
procedures, and services for claims reporting is called coding.
b. Incorrect. Data processing is the collection and manipulation of data to produce
meaningful information. The process of assigning numeric and alphanumeric characters
to diagnoses, procedures, and services for claims reporting is called coding.
c. Incorrect. Programming is the process of creating executable computer software
programs that instruct the computer to perform specific tasks. The process of
assigning numeric and alphanumeric characters to diagnoses, procedures, and services
for claims reporting is called coding.
d. Incorrect. Reimbursement is the payment a provider receives for performing procedures
and providing services or supplies. The process of assigning numeric and alphanumeric
characters to diagnoses, procedures, and services for claims reporting is called coding.
© 2026 3
i
, Solution and Answer Guide: Michelle A. Green, Understanding Health Insurance: A Guide to Billing and
Reimbursement: 2026, 21st Edition, 9798214482088; Chapter 1: Health Insurance Specialist Career
6. If a health insurance plan’s prior approval requirements are not met by providers and
the claim is submitted for reimbursement,
a. administrative costs are reduced.
b. patients’ coverage is cancelled.
c. payment of the claim is denied.
d. they pay a fine to the health plan.
ANS: c
Analysis:
a. Incorrect. Administrative costs actually increase as a result of billing the patient
for services provided, submitting the bill to collections, and writing off the billed
amount. If a health insurance plan’s prior approval requirements are not met by
providers and the claim is submitted for reimbursement, the third-party payer
issues claims denials.
b. Incorrect. The patient’s coverage is not cancelled when prior approval requirements
are not met, but the payer may deny the claim. If a health insurance plan’s prior
approval requirements are not met by providers and the claim is submitted for
reimbursement, the third-party payer issues claims denials.
c. Correct. If a health insurance plan’s prior approval requirements are not met by
providers and the claim is submitted for reimbursement, the third-party payer
issues claims denials.
d. Incorrect. Providers and patients do not pay a fine to the health plan when prior
approval requirements are not met. If a health insurance plan’s prior approval
requirements are not met by providers and the claim is submitted for
reimbursement, the third-party payer issues claims denials.
7. Which coding system is used to report diagnoses and conditions on claims?
a. CPT
b. HCPCS Level II
c. ICD-10-CM
d. ICD-10-PCS
ANS: c
Analysis:
a. Incorrect. CPT, or Current Procedural Terminology, is used to report procedures or
services on outpatient and physician office claims. ICD-10-CM, or International
Classification of Diseases, 10th Revision, Clinical Modification, is used to report
diagnoses and conditions on all claims.
b. Incorrect. HCPCS Level II, or Healthcare Common Procedure Coding System Level II,
codes are used to report procedures or services on outpatient and physician office
claims, especially for medical devices, supplies, and drugs. ICD-10-CM, or International
Classification of Diseases, 10th Revision, Clinical Modification, is used to report
diagnoses and conditions on all claims.
c. Correct. ICD-10-CM, or International Classification of Diseases, 10th Revision,
Clinical Modification, is used to report diagnoses and conditions on all claims.
d. Incorrect. ICD-10-PCS, or International Classification of Diseases, 10th Revision,
Procedure Coding System, is used to report inpatient hospital procedures or services
on UB-04 claims. ICD-10-CM, or International Classification of Diseases, 10th Revision,
Clinical Modification, is used to report diagnoses and conditions on all claims.
© 2026 4
i
