Guide to Billing and Reimbursement, 2024 Edition,
19th Edition Michelle A. Green
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,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.
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
LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and
the parties involved.
DATE CREATED: 12/11/2023 3:17 PM
DATE MODIFIED: 12/11/2023 3:17 PM
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
LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and
the parties involved.
DATE CREATED: 12/11/2023 3:17 PM
DATE MODIFIED: 12/11/2023 3:17 PM
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 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_24_1.2 - Briefly summarize health insurance claims processing and
the parties involved.
UHI_GREEN_24_1.3 - Identify career opportunities available for health insurance
specialists.
DATE CREATED: 12/11/2023 3:17 PM
DATE MODIFIED: 12/11/2023 3:30 PM
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,Name: Class: Date:
Chapter 01: Health Insurance Specialist Career
4. Which is another name for a health insurance specialist?
a. billing specialist
b. coding specialist
c. health information specialist
d. reimbursement specialist
ANSWER: d
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.3 - Identify career opportunities available for health insurance
specialists.
DATE CREATED: 12/11/2023 3:17 PM
DATE MODIFIED: 12/11/2023 3:17 PM
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
LEARNING OBJECTIVES: UHI_GREEN_24_1.3 - Identify career opportunities available for health insurance
specialists.
DATE CREATED: 12/11/2023 3:17 PM
DATE MODIFIED: 12/11/2023 3:17 PM
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
b. diagnosis coding
c. medical necessity
d. reimbursement processing
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and
the parties involved.
DATE CREATED: 12/11/2023 3:17 PM
DATE MODIFIED: 12/11/2023 3:30 PM
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,Name: Class: Date:
Chapter 01: Health Insurance Specialist Career
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
LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and
the parties involved.
DATE CREATED: 12/11/2023 3:17 PM
DATE MODIFIED: 12/11/2023 3:17 PM
8. Which is submitted to the payer requesting reimbursement?
a. explanation of benefits
b. health insurance claim
c. remittance advice
d. prior approval form
ANSWER: b
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.5 - Describe the job responsibilities of a health insurance
specialist.
DATE CREATED: 12/11/2023 3:17 PM
DATE MODIFIED: 12/11/2023 3:17 PM
9. The Centers for Medicare and Medicaid Services (CMS) administrative agency is located in the __________.
a. ACF
b. DHHS
c. FDA
d. OIG
ANSWER: b
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and
the parties involved.
DATE CREATED: 12/11/2023 3:17 PM
DATE MODIFIED: 12/11/2023 3:31 PM
10. When a health insurance plan’s prior approval requirements are not met by providers,
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,Name: Class: Date:
Chapter 01: Health Insurance Specialist Career
a. administrative costs are reduced.
b. patients’ coverage is canceled.
c. payment of the claim is denied.
d. providers pay a fine to the plan.
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and
the parties involved.
DATE CREATED: 12/11/2023 3:17 PM
DATE MODIFIED: 12/11/2023 3:17 PM
11. Which coding system is used to report procedures and services on claims?
a. CPT
b. ICD-10-CM
c. SNDO
d. SNOMED
ANSWER: a
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and
the parties involved.
DATE CREATED: 12/11/2023 3:17 PM
DATE MODIFIED: 12/11/2023 3:17 PM
12. Which would be found on a remittance advice?
a. detected errors and omissions from claims
b. documentation of medical necessity
c. payment information about a claim
d. provider qualifications and responsibilities
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.5 - Describe the job responsibilities of a health insurance
specialist.
DATE CREATED: 12/11/2023 3:17 PM
DATE MODIFIED: 12/11/2023 3:17 PM
13. Which guarantees repayment for financial losses resulting from an employee’s act or failure to act?
a. bonding insurance
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,Name: Class: Date:
Chapter 01: Health Insurance Specialist Career
b. liability insurance
c. property insurance
d. workers’ compensation insurance
ANSWER: a
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.6 - Differentiate among types of insurance purchased by
contractors and employers.
DATE CREATED: 12/11/2023 3:17 PM
DATE MODIFIED: 12/11/2023 3:17 PM
14. Medical malpractice insurance is which type of insurance?
a. bonding
b. liability
c. property
d. workers’ compensation
ANSWER: b
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.6 - Differentiate among types of insurance purchased by
contractors and employers.
DATE CREATED: 12/11/2023 3:17 PM
DATE MODIFIED: 12/11/2023 3:17 PM
15. Which type of insurance covers employees and their dependents against injury and death during employment?
a. bonding
b. liability
c. property
d. workers’ compensation
ANSWER: d
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.6 - Differentiate among types of insurance purchased by
contractors and employers.
DATE CREATED: 12/11/2023 3:17 PM
DATE MODIFIED: 12/11/2023 3:32 PM
16. The word embezzle means to _____.
a. compensate
b. disburse
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,Name: Class: Date:
Chapter 01: Health Insurance Specialist Career
c. remunerate
d. steal
ANSWER: d
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.6 - Differentiate among types of insurance purchased by
contractors and employers.
DATE CREATED: 12/11/2023 3:17 PM
DATE MODIFIED: 12/11/2023 3:17 PM
17. Independent contractors should purchase __________ liability insurance, which protects from liability as a result of
errors and omissions when performing their professional services.
a. bonding
b. business
c. professional
d. property
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.6 - Differentiate among types of insurance purchased by
contractors and employers.
DATE CREATED: 12/11/2023 3:17 PM
DATE MODIFIED: 12/11/2023 3:33 PM
18. Which term describes the principles of right or good conduct and includes rules that govern the conduct of members of
a profession?
a. biased
b. ethics
c. immoral
d. misleading
ANSWER: b
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.7 - Explain the role of workplace professionalism for a health
insurance specialist.
DATE CREATED: 12/11/2023 3:17 PM
DATE MODIFIED: 12/11/2023 3:17 PM
19. The Healthcare Common Procedure Coding System (HCPCS) consists of __________ codes.
a. CPT and national
b. DSM and CDT
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,Name: Class: Date:
Chapter 01: Health Insurance Specialist Career
c. ICD-10-CM and ICD-10-PCS
d. SNOMED and SNDO
ANSWER: a
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and
the parties involved.
DATE CREATED: 12/11/2023 3:17 PM
DATE MODIFIED: 12/11/2023 3:17 PM
20. Health information technicians _____.
a. assist with direct patient care
b. document clinical information
c. manage medical records
d. process health insurance claims
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.3 - Identify career opportunities available for health insurance
specialists.
DATE CREATED: 12/11/2023 3:17 PM
DATE MODIFIED: 12/11/2023 3:17 PM
21. The organization that hires a(n) __________ is not liable for the acts or omissions of that individual.
a. health insurance specialist
b. health care provider
c. independent contractor
d. medical assistant
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.6 - Differentiate among types of insurance purchased by
contractors and employers.
DATE CREATED: 12/11/2023 3:17 PM
DATE MODIFIED: 12/11/2023 3:17 PM
22. During the completion of a student internship, the facility will likely require students to sign a nondisclosure
agreement to protect __________.
a. facility resources
b. health care finances
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, Name: Class: Date:
Chapter 01: Health Insurance Specialist Career
c. patient confidentiality
d. quality of patient care
ANSWER: c
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.4 - List the education and training requirements of a health
insurance specialist.
DATE CREATED: 12/11/2023 3:17 PM
DATE MODIFIED: 12/11/2023 3:33 PM
23. Which coding system is used to report procedures and services on inpatient hospital claims?
a. CPT
b. HCPCS level II
c. ICD-10-CM
d. ICD-10-PCS
ANSWER: d
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and
the parties involved.
DATE CREATED: 12/11/2023 3:17 PM
DATE MODIFIED: 12/11/2023 3:17 PM
24. Who does a provider usually employ to perform administrative and clinical tasks which help keep the office or
clinic running smoothly?
a. health information technician
b. medical assistant
c. nurse practitioner
d. reimbursement specialist
ANSWER: b
POINTS: 1
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
LEARNING OBJECTIVES: UHI_GREEN_24_1.3 - Identify career opportunities available for health insurance
specialists.
DATE CREATED: 12/11/2023 3:17 PM
DATE MODIFIED: 12/11/2023 3:34 PM
25. Which organization offers the CPB exam?
a. AAPC
b. AHIMA
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