Name Clas Dat
: s: e:
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. was required to pay any amounts that the insurance plan denies.
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 7/19/2019 2:53 PM
DATE MODIFIED: 9/16/2019 5:28 AM
2. The process of reporting __________ as numeric and alphanumeric characters on the insurance claim is called coding.
a. dates of service for procedures
b. diagnoses and procedures/services
c. health insurance claims identifiers
d. national provider identifiers
ANSWER: b
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 7/19/2019 2:53 PM
DATE MODIFIED: 9/16/2019 5:30 AM
3. A claims examiner employed by a third-party payer 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 medical necessity of services/procedures.
d. resubmitting denied claims to health care providers.
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 7/19/2019 2:53 PM
DATE MODIFIED: 9/16/2019 5:33 AM
4. Which is another name for a health insurance specialist?
a. billing specialist
b. coding specialist
c. health information specialist
d. reimbursement specialist
Copyright Cengage Learning. Powered by Cognero. Page 1
, Name Clas Dat
: s: e:
Chapter 01: Health Insurance Specialist Career
ANSWER: d
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 7/19/2019 2:53 PM
DATE MODIFIED: 9/16/2019 5:35 AM
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
DATE CREATED: 7/19/2019 2:53 PM
DATE MODIFIED: 9/16/2019 5:36 AM
6. Which involves linking every procedure or service code reported on the claim to a condition code that justifies the
necessity of 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
DATE CREATED: 7/19/2019 2:53 PM
DATE MODIFIED: 9/16/2019 5:38 AM
7. The CPT manual is published by the
a. American Billing Association.
b. American Board of Physicians.
c. American Dental Association.
d. American Medical Association.
ANSWER: d
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 7/19/2019 2:53 PM
Copyright Cengage Learning. Powered by Cognero. Page 2
: s: e:
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. was required to pay any amounts that the insurance plan denies.
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 7/19/2019 2:53 PM
DATE MODIFIED: 9/16/2019 5:28 AM
2. The process of reporting __________ as numeric and alphanumeric characters on the insurance claim is called coding.
a. dates of service for procedures
b. diagnoses and procedures/services
c. health insurance claims identifiers
d. national provider identifiers
ANSWER: b
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 7/19/2019 2:53 PM
DATE MODIFIED: 9/16/2019 5:30 AM
3. A claims examiner employed by a third-party payer 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 medical necessity of services/procedures.
d. resubmitting denied claims to health care providers.
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 7/19/2019 2:53 PM
DATE MODIFIED: 9/16/2019 5:33 AM
4. Which is another name for a health insurance specialist?
a. billing specialist
b. coding specialist
c. health information specialist
d. reimbursement specialist
Copyright Cengage Learning. Powered by Cognero. Page 1
, Name Clas Dat
: s: e:
Chapter 01: Health Insurance Specialist Career
ANSWER: d
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 7/19/2019 2:53 PM
DATE MODIFIED: 9/16/2019 5:35 AM
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
DATE CREATED: 7/19/2019 2:53 PM
DATE MODIFIED: 9/16/2019 5:36 AM
6. Which involves linking every procedure or service code reported on the claim to a condition code that justifies the
necessity of 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
DATE CREATED: 7/19/2019 2:53 PM
DATE MODIFIED: 9/16/2019 5:38 AM
7. The CPT manual is published by the
a. American Billing Association.
b. American Board of Physicians.
c. American Dental Association.
d. American Medical Association.
ANSWER: d
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
DATE CREATED: 7/19/2019 2:53 PM
Copyright Cengage Learning. Powered by Cognero. Page 2
