Solutions for Understanding Health Insurance, A Guide to Billing and Reimbursement, 2025 Edition, 20th Edition by Green (All Chapters included)

Understanding Health Insurance, A
Guide to Billing and
Reimbursement, 2025 Edition, 20th
Edition by Michelle A. Green



Complete Chapter Solutions Manual
are included (Ch 1 to 16)




** Immediate Download
** Swift Response
** All Chapters included

,Table of Contents are given below

Chapter 1. Health Insurance Specialist Career
Chapter 2. Introduction to Health Insurance and Managed Care
Chapter 3. Introduction to Revenue Management
Chapter 4. Revenue Management: Insurance Claims, Denied
Claims and Appeals, and Credit and Collections
Chapter 5. Legal Aspects of Health Insurance and Reimbursement
Chapter 6. ICD-10-CM Coding
Chapter 7. CPT Coding
Chapter 8. HCPCS Level II Coding
Chapter 9. CMS Reimbursement Methodologies
Chapter 10. CMS-1500 and UB-04 Claims
Chapter 11. Commercial Insurance
Chapter 12. BlueCross BlueShield
Chapter 13. Medicare
Chapter 14. Medicaid
Chapter 15. TRICARE
Chapter 16. Workers’ Compensation

,Solution and Answer Guide
MICHELLE A. GREEN, UNDERSTANDING HEALTH INSURANCE : A GUIDE TO BILLING AND
REIMBURSEMENT : 2025, 20TH EDITION, 9798214112978; 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.




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, 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.




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