TEST BANK
Understanding Health Insurance: A Guide
to Billing and Reimbursement
ST
Michelle A. Green
──────────────────────────────────────────────────
UV
20th Edition
IA
?_
AP
PR
OV
ED
? ?
, TABLE OF CONTENTS
R
Understanding Health Insurance: A Guide to Billing and Reimbursement 2025 (20 Edition)
U
- Test Bank
ST
SE
Chapter 1 Health Insurance Specialist Career
UV
Chapter 2 Introduction to Health Insurance and Managed Care
IS
Chapter 3 Introduction to Revenue Management
O
Chapter 4 Revenue Management: Insurance Claims, Denied Claims and Appeals, and Credit and
IA
Collections
Chapter 5 N
Legal Aspects of Health Insurance and Reimbursement
N
?_
Chapter 6 ICD-10-CM Coding
O
Chapter 7 CPT Coding
C
Chapter 8 HCPCS Level II Coding
AP
ED
Chapter 9 CMS Reimbursement Methodologies
Chapter 10 CMS-1500 and UB-04 Claims
PR
M
Chapter 11 Commercial Insurance
Chapter 12 BlueCross BlueShield
Chapter 13 Medicare
OV
Chapter 14 Medicaid
Chapter 15 TRICARE
Chapter 16 Workers’ Compensation
ED
??
,Name: Class: Date:
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.
ST
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
UV
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_26_1.1 - Briefly summarize health insurance claims processing and
the parties involved.
IA
DATE CREATED: 1/10/2025 12:46 AM
DATE MODIFIED: 1/10/2025 12:46 AM
2. The process of reporting diagnoses and procedures/services as numeric and alphanumeric characters on the insurance
?_
claim is called .
a. transcribing
b. coding
AP
c. reporting
d. auditing
ANSWER: b
POINTS: 1
QUESTION TYPE: Multiple Choice
PR
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_26_1.1 - Briefly summarize health insurance claims processing and
the parties involved.
DATE CREATED: 1/10/2025 12:46 AM
OV
DATE MODIFIED: 1/10/2025 12:46 AM
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.
ED
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: UHI_GREEN_26_1.1 - Briefly summarize health insurance claims processing and
the parties involved.
UHI_GREEN_26_1.2 - Identify career opportunities available for health insurance
specialists.
DATE CREATED: 1/10/2025 12:46 AM
DATE MODIFIED: 1/10/2025 12:46 AM
, Name: Class: Date:
Chapter 01 - Health Insurance Specialist Career
4. Which is another name for a health insurance specialist?
a. Billing specialist
ST
b. Coding specialist
c. Health information specialist
d. Reimbursement specialist
ANSWER: d
UV
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_26_1.2 - Identify career opportunities available for health insurance
IA
specialists.
DATE CREATED: 1/10/2025 12:46 AM
DATE MODIFIED: 1/10/2025 12:46 AM
?_
5. A claims examiner is employed by a
a. facility to submit claims.
b. governmental agency to process claims.
AP
c. physician’s office to submit claims.
d. third-party payer to review claims.
ANSWER: d
POINTS: 1
QUESTION TYPE: Multiple Choice
PR
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_26_1.2 - Identify career opportunities available for health insurance
specialists.
DATE CREATED: 1/10/2025 12:46 AM
OV
DATE MODIFIED: 1/10/2025 12:46 AM
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
ED
b. Diagnosis coding
c. Medical necessity
d. Reimbursement processing
ANSWER: c
??
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_26_1.1 - Briefly summarize health insurance claims processing and
the parties involved.
DATE CREATED: 1/10/2025 12:46 AM
DATE MODIFIED: 1/10/2025 12:46 AM
Understanding Health Insurance: A Guide
to Billing and Reimbursement
ST
Michelle A. Green
──────────────────────────────────────────────────
UV
20th Edition
IA
?_
AP
PR
OV
ED
? ?
, TABLE OF CONTENTS
R
Understanding Health Insurance: A Guide to Billing and Reimbursement 2025 (20 Edition)
U
- Test Bank
ST
SE
Chapter 1 Health Insurance Specialist Career
UV
Chapter 2 Introduction to Health Insurance and Managed Care
IS
Chapter 3 Introduction to Revenue Management
O
Chapter 4 Revenue Management: Insurance Claims, Denied Claims and Appeals, and Credit and
IA
Collections
Chapter 5 N
Legal Aspects of Health Insurance and Reimbursement
N
?_
Chapter 6 ICD-10-CM Coding
O
Chapter 7 CPT Coding
C
Chapter 8 HCPCS Level II Coding
AP
ED
Chapter 9 CMS Reimbursement Methodologies
Chapter 10 CMS-1500 and UB-04 Claims
PR
M
Chapter 11 Commercial Insurance
Chapter 12 BlueCross BlueShield
Chapter 13 Medicare
OV
Chapter 14 Medicaid
Chapter 15 TRICARE
Chapter 16 Workers’ Compensation
ED
??
,Name: Class: Date:
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.
ST
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
UV
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_26_1.1 - Briefly summarize health insurance claims processing and
the parties involved.
IA
DATE CREATED: 1/10/2025 12:46 AM
DATE MODIFIED: 1/10/2025 12:46 AM
2. The process of reporting diagnoses and procedures/services as numeric and alphanumeric characters on the insurance
?_
claim is called .
a. transcribing
b. coding
AP
c. reporting
d. auditing
ANSWER: b
POINTS: 1
QUESTION TYPE: Multiple Choice
PR
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_26_1.1 - Briefly summarize health insurance claims processing and
the parties involved.
DATE CREATED: 1/10/2025 12:46 AM
OV
DATE MODIFIED: 1/10/2025 12:46 AM
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.
ED
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: UHI_GREEN_26_1.1 - Briefly summarize health insurance claims processing and
the parties involved.
UHI_GREEN_26_1.2 - Identify career opportunities available for health insurance
specialists.
DATE CREATED: 1/10/2025 12:46 AM
DATE MODIFIED: 1/10/2025 12:46 AM
, Name: Class: Date:
Chapter 01 - Health Insurance Specialist Career
4. Which is another name for a health insurance specialist?
a. Billing specialist
ST
b. Coding specialist
c. Health information specialist
d. Reimbursement specialist
ANSWER: d
UV
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_26_1.2 - Identify career opportunities available for health insurance
IA
specialists.
DATE CREATED: 1/10/2025 12:46 AM
DATE MODIFIED: 1/10/2025 12:46 AM
?_
5. A claims examiner is employed by a
a. facility to submit claims.
b. governmental agency to process claims.
AP
c. physician’s office to submit claims.
d. third-party payer to review claims.
ANSWER: d
POINTS: 1
QUESTION TYPE: Multiple Choice
PR
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_26_1.2 - Identify career opportunities available for health insurance
specialists.
DATE CREATED: 1/10/2025 12:46 AM
OV
DATE MODIFIED: 1/10/2025 12:46 AM
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
ED
b. Diagnosis coding
c. Medical necessity
d. Reimbursement processing
ANSWER: c
??
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_26_1.1 - Briefly summarize health insurance claims processing and
the parties involved.
DATE CREATED: 1/10/2025 12:46 AM
DATE MODIFIED: 1/10/2025 12:46 AM
