My AAPC CPB - Chapter 12 Review
The term for the set payment that the member pays to the healthcare provider on the day of
service is the:
a. office visit fee.
b. co-insurance.
c. copay.
d. co-signer. - correct answer-c. copay.
Blue Cross/Blue Shield identifies the individual or employee who pays for healthcare
insurance coverage as the:
a. Member
b. Group
c. Subscriber
d. Payer - correct answer-c. Subscriber
What information can be found on the Blue Cross/Blue Shield insurance identification card?
I. Type of plan
II. Subscriber's address and phone number
III. ID number
IV. Group number
V. Name of primary care provider
VI. Phone number for Member Services/Benefits questions
VII. Mailing address of BC/BS office
a. II, V, VII
b. I, III, IV, VI
c. V, VI, VII
d. I, III, IV, VI, VII - correct answer-d. I, III, IV, VI, VII
The Blue Cross/Blue Shield member's insurance card will list which of the following:
a. provider's name.
b. type of insurance.
c. type of plan.
d. both b & c. - correct answer-d. both b & c.
The document reporting the benefits applied to a Blue Cross/Blue Shield claim is the:
a. Explanation of Payment (EOP).
b. Explanation of Benefits (EOB).
c. Explanation of Coverage (EOC).
d. None of the above. - correct answer-b. Explanation of Benefits (EOB).
, Blue Cross and Blue Shield is the:
a. oldest and smallest family of health benefits companies in the United States.
b. newest and largest family of health benefits companies in the United States.
c. oldest and largest family of health benefits companies in the United States.
d. only health insurance company promoting preferred provider organizations. - correct
answer-c. oldest and largest family of health benefits companies in the United States.
Blue Cross/Blue Shield offers which type of Medicare plan?
a. Medicare Plus
b. Medicare Advantage
c. Medicare Part G
d. Medicare Add-on - correct answer-b. Medicare Advantage
Developing a strong relationship with the insurance Provider Representative will result in:
a. difficulty resolving claim payment issues.
b. problems with provider credentialing.
c. increased ability to resolve billing, contracting issues that may arise.
d. both a & b. - correct answer-c. increased ability to resolve billing, contracting issues that
may arise.
A Blue Cross/Blue Shield insurance plan that allows members to choose any provider, but
offers higher levels of coverage when members obtain services from network providers
would be an example of:
a. Health Maintenance Organization (HMO)
b. Point of Service (POS)
c. Preferred Provider Organization (PPO)
d. Indemnity - correct answer-c. Preferred Provider Organization (PPO)
Tony's Blue Cross/Blue Shield healthcare insurance policy states that he must seek
healthcare services only from providers that are part of a specific network. What type of Blue
Cross/Blue Shield plan does Tony have?
a. POS
b. HMO
c. Fee-for-Service
d. Indemnity - correct answer-b. HMO
Obtaining approval from the insurance payer before a procedure is performed is known as:
a. prior authorization.
b. prior approval.
c. initial approval.
d. initial authorization. - correct answer-a. prior authorization.
The term for the set payment that the member pays to the healthcare provider on the day of
service is the:
a. office visit fee.
b. co-insurance.
c. copay.
d. co-signer. - correct answer-c. copay.
Blue Cross/Blue Shield identifies the individual or employee who pays for healthcare
insurance coverage as the:
a. Member
b. Group
c. Subscriber
d. Payer - correct answer-c. Subscriber
What information can be found on the Blue Cross/Blue Shield insurance identification card?
I. Type of plan
II. Subscriber's address and phone number
III. ID number
IV. Group number
V. Name of primary care provider
VI. Phone number for Member Services/Benefits questions
VII. Mailing address of BC/BS office
a. II, V, VII
b. I, III, IV, VI
c. V, VI, VII
d. I, III, IV, VI, VII - correct answer-d. I, III, IV, VI, VII
The Blue Cross/Blue Shield member's insurance card will list which of the following:
a. provider's name.
b. type of insurance.
c. type of plan.
d. both b & c. - correct answer-d. both b & c.
The document reporting the benefits applied to a Blue Cross/Blue Shield claim is the:
a. Explanation of Payment (EOP).
b. Explanation of Benefits (EOB).
c. Explanation of Coverage (EOC).
d. None of the above. - correct answer-b. Explanation of Benefits (EOB).
, Blue Cross and Blue Shield is the:
a. oldest and smallest family of health benefits companies in the United States.
b. newest and largest family of health benefits companies in the United States.
c. oldest and largest family of health benefits companies in the United States.
d. only health insurance company promoting preferred provider organizations. - correct
answer-c. oldest and largest family of health benefits companies in the United States.
Blue Cross/Blue Shield offers which type of Medicare plan?
a. Medicare Plus
b. Medicare Advantage
c. Medicare Part G
d. Medicare Add-on - correct answer-b. Medicare Advantage
Developing a strong relationship with the insurance Provider Representative will result in:
a. difficulty resolving claim payment issues.
b. problems with provider credentialing.
c. increased ability to resolve billing, contracting issues that may arise.
d. both a & b. - correct answer-c. increased ability to resolve billing, contracting issues that
may arise.
A Blue Cross/Blue Shield insurance plan that allows members to choose any provider, but
offers higher levels of coverage when members obtain services from network providers
would be an example of:
a. Health Maintenance Organization (HMO)
b. Point of Service (POS)
c. Preferred Provider Organization (PPO)
d. Indemnity - correct answer-c. Preferred Provider Organization (PPO)
Tony's Blue Cross/Blue Shield healthcare insurance policy states that he must seek
healthcare services only from providers that are part of a specific network. What type of Blue
Cross/Blue Shield plan does Tony have?
a. POS
b. HMO
c. Fee-for-Service
d. Indemnity - correct answer-b. HMO
Obtaining approval from the insurance payer before a procedure is performed is known as:
a. prior authorization.
b. prior approval.
c. initial approval.
d. initial authorization. - correct answer-a. prior authorization.
