NCCT INTERACTIVE REVIEW MEDICAL INSURANCE EXAM
QUESTIONS AND ANSWERS
Place the options below in order of claim submission, where all insurances are
relevant.
Humana
ABC Auto
Medicaid
Medicare
ABC Auto
Humana
Medicare
Medicaid
It is highly unlikely that a patient would have all four of these insurances. However, if
they do, the order in which the claims are submitted is relevant. It is assumed that since
there is auto insurance involved, that this claim has to do with an automobile accident.
The auto insurance should be filed first. Humana, a private payer, should be filed next.
Government insurance, such as Medicare and Medicaid, should always be submitted
last. When both Medicare and Medicaid are valid, Medicaid should be billed last.
Eligibility for Medicaid may change as quickly as
A. daily.
B. weekly.
C. monthly.
D. yearly.
C. monthly.
Medicaid coverage determination is monthly. For example, if a person is eligible for
coverage on April 2, they are also eligible for coverage on April 25. Eligibility will not
change more or less frequently than monthly.
Which of the following processes requires checking and confirming that the
patient is a member of the insurance plan and that the member identification
number is correct?
A. precertification
,B. prior authorization
C. verification
D. referral
C. verification
The process of insurance verification is the confirmation that the patient is a member of
the insurance plan and that the member identification number is correct. This process
should be done every time the patient comes to the office, as insurance can change at
any time. Precertification is obtained for particular services and is obtained from the
insurance company prior to those services being rendered. Precertification has to do
with medical necessity if it is deemed that the patient's diagnosis is a proper reason to
have a service. Prior authorization is the approval from the insurance company to
provide a service. A referral is required for some patients to see a specialist. Not all
insurance policies require referrals.
The patient is a 3-year-old. Both parents have private insurance coverage on the
patient, and the mother has a Healthcare Savings Account. The primary insurance
belongs to the parent
A. who was born first (oldest).
B. with the Healthcare Savings Account.
C. with the earlier birthday in the year.
D. with the best insurance benefit coverage.
C. with the earlier birthday in the year.
According to the birthday rule, the primary insurance belongs to the parent with the
earlier birthday in the year. A Healthcare Savings Account is an account in which a
person saves money to be spent on healthcare services which is not connected to an
insurance company. It does not matter who is oldest or who has the best coverage
when it comes to coordination of benefits.
A child was seen by her pediatrician. The child is covered under both her father's
and mother's insurance. According to the "Birthday Rule," the mother's insurance
is primary. Why?
A. The mother is older than the father.
B. The mother's insurance has a lower deductible.
, C. The mother's birthday comes first in the calendar year.
D. The mother's insurance has a higher coverage rate.
C. The mother's birthday comes first in the calendar year.
Which of the following statements is true concerning a court order about
children's health coverage after a divorce?
A. The primary plan belongs to the parent whose birthday falls closest to the
beginning of the year.
B. Divorce rulings have no effect on primary and secondary polices.
C. The primary plan belongs to the parent whose policy was effective the longest.
D. Divorce rulings override the birthday rule.
D. Divorce rulings override the birthday rule.
Usually, when assessing the coordination of benefits, the birthday rule is used to
determine the primary insurance for a child. However, during a divorce, a judge may
rule which parent is primarily responsible for a child's medical coverage. Divorce
Divorce rulings override the birthday rule.
If a married couple is covered under both spouses' health insurance and the
husband is picking up a prescription for himself, he should
A. get to pick which insurance benefits to use at the pharmacy.
B. use the insurance benefits with the least expensive out of pocket expense.
C. use his insurance benefits alone unless he forgot to bring the insurance card.
D. use both of insurance benefits as they apply to this pharmacy purchase.
D. use both of insurance benefits as they apply to this pharmacy purchase.
The patient should use his insurance as primary and then should use his spouse's
insurance as a secondary for the prescription coverage.
A patient has just left the doctor's office with a new prescription after a scheduled
follow up visit. If the patient's primary insurance covers the bill completely, her
secondary insurance policy
A. is still going to be billed for the medications.
B. is still going to pay the fee schedule amount for the visit.
C. will not be used for this visit.
D. will apply the primary payment to the lifetime maximum amount.
QUESTIONS AND ANSWERS
Place the options below in order of claim submission, where all insurances are
relevant.
Humana
ABC Auto
Medicaid
Medicare
ABC Auto
Humana
Medicare
Medicaid
It is highly unlikely that a patient would have all four of these insurances. However, if
they do, the order in which the claims are submitted is relevant. It is assumed that since
there is auto insurance involved, that this claim has to do with an automobile accident.
The auto insurance should be filed first. Humana, a private payer, should be filed next.
Government insurance, such as Medicare and Medicaid, should always be submitted
last. When both Medicare and Medicaid are valid, Medicaid should be billed last.
Eligibility for Medicaid may change as quickly as
A. daily.
B. weekly.
C. monthly.
D. yearly.
C. monthly.
Medicaid coverage determination is monthly. For example, if a person is eligible for
coverage on April 2, they are also eligible for coverage on April 25. Eligibility will not
change more or less frequently than monthly.
Which of the following processes requires checking and confirming that the
patient is a member of the insurance plan and that the member identification
number is correct?
A. precertification
,B. prior authorization
C. verification
D. referral
C. verification
The process of insurance verification is the confirmation that the patient is a member of
the insurance plan and that the member identification number is correct. This process
should be done every time the patient comes to the office, as insurance can change at
any time. Precertification is obtained for particular services and is obtained from the
insurance company prior to those services being rendered. Precertification has to do
with medical necessity if it is deemed that the patient's diagnosis is a proper reason to
have a service. Prior authorization is the approval from the insurance company to
provide a service. A referral is required for some patients to see a specialist. Not all
insurance policies require referrals.
The patient is a 3-year-old. Both parents have private insurance coverage on the
patient, and the mother has a Healthcare Savings Account. The primary insurance
belongs to the parent
A. who was born first (oldest).
B. with the Healthcare Savings Account.
C. with the earlier birthday in the year.
D. with the best insurance benefit coverage.
C. with the earlier birthday in the year.
According to the birthday rule, the primary insurance belongs to the parent with the
earlier birthday in the year. A Healthcare Savings Account is an account in which a
person saves money to be spent on healthcare services which is not connected to an
insurance company. It does not matter who is oldest or who has the best coverage
when it comes to coordination of benefits.
A child was seen by her pediatrician. The child is covered under both her father's
and mother's insurance. According to the "Birthday Rule," the mother's insurance
is primary. Why?
A. The mother is older than the father.
B. The mother's insurance has a lower deductible.
, C. The mother's birthday comes first in the calendar year.
D. The mother's insurance has a higher coverage rate.
C. The mother's birthday comes first in the calendar year.
Which of the following statements is true concerning a court order about
children's health coverage after a divorce?
A. The primary plan belongs to the parent whose birthday falls closest to the
beginning of the year.
B. Divorce rulings have no effect on primary and secondary polices.
C. The primary plan belongs to the parent whose policy was effective the longest.
D. Divorce rulings override the birthday rule.
D. Divorce rulings override the birthday rule.
Usually, when assessing the coordination of benefits, the birthday rule is used to
determine the primary insurance for a child. However, during a divorce, a judge may
rule which parent is primarily responsible for a child's medical coverage. Divorce
Divorce rulings override the birthday rule.
If a married couple is covered under both spouses' health insurance and the
husband is picking up a prescription for himself, he should
A. get to pick which insurance benefits to use at the pharmacy.
B. use the insurance benefits with the least expensive out of pocket expense.
C. use his insurance benefits alone unless he forgot to bring the insurance card.
D. use both of insurance benefits as they apply to this pharmacy purchase.
D. use both of insurance benefits as they apply to this pharmacy purchase.
The patient should use his insurance as primary and then should use his spouse's
insurance as a secondary for the prescription coverage.
A patient has just left the doctor's office with a new prescription after a scheduled
follow up visit. If the patient's primary insurance covers the bill completely, her
secondary insurance policy
A. is still going to be billed for the medications.
B. is still going to pay the fee schedule amount for the visit.
C. will not be used for this visit.
D. will apply the primary payment to the lifetime maximum amount.
