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MNT II: Billing and Coding Exam Practice Questions and Answers

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MNT II: Billing and Coding Exam Practice Questions and Answers Health care provider or supplier agrees (or is required by law to accept the third party payer-approved amount as full payment for covered services and not to bill the client for any more than the deductible and coinsurance. - Ans:-...

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©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED

FIRST PUBLISH OCTOBER 2024

MNT II: Billing and Coding Exam
Practice Questions and Answers

Health care provider or supplier agrees (or is required by law to accept the third party payer-approved

amount as full payment for covered services and not to bill the client for any more than the deductible

and coinsurance. - Ans:✔✔-Accept Assignment

A group of care providers who give coordinate care and chronic disease management, and thereby

improve the quality of care patients get. The organization's payment is tied to achieving health care

quality goals and outcomes that result in cost saving. - Ans:✔✔-Accountable Care Organization

The amount of money charged by the health care provider or supplier for a certain medical service or

supply. This amount is often more than the amount Medicare or third party payers approve. - Ans:✔✔-

Actual charge

May also be known as a waiver of liability. A notice health care providers and suppliers are required to

give and have signed by Original Medicare when they believe that Medicare will not cover the services or

items and the person has no reason to know that Medicare will not cover these services or items. If no

ABN is not provided by provider, the Medicare insured does not have to pay but if he/she signed an ABN

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, ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED

FIRST PUBLISH OCTOBER 2024

for the service/item then they are responsible and Medicare does not have to pay. - Ans:✔✔-Advance

Beneficiary Notice (ABN)

Generic term referring to the maximum fee that a third party will use to reimburse a provider for a given

service. - Ans:✔✔-Allowable charge

A request by a beneficiary or a provider to have a review when health care services are denied based on

medical necessity or appropriateness, or improperly paid. - Ans:✔✔-Appeal

A referral that has been submitted to the patient's insurance company for approval for the services

requested to be performed. - Ans:✔✔-Authorization

Balance billing is the practice of billing a patient for charges not paid by his/her insurance plan because

the charges are in excess of covered amounts. Balance billing amount will often be charges that are

beyond the fee schedule or contract rate. - Ans:✔✔-Balance Bill

A person who is covered by the third party payer - Ans:✔✔-Beneficiary

The specified period of time during which charges for covered services must be incurred in order to be

eligible for payment by a third party payer. - Ans:✔✔-Benefit period

The reimbursement of health care providers (such as hospitals and physicians) on the basis of expected

costs for clinically-defined episodes of care. It has been described as a "middle ground" between fee for

service reimbursement (in which providers are paid for each service rendered to a patient) and

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, ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED

FIRST PUBLISH OCTOBER 2024

capitation (in which providers are paid a "lump sum" per patient regardless of how many services the

patient receives).

Bundled payments have been proposed in the health care reform debate in the United States as a

strategy for reducing health care costs. - Ans:✔✔-Bundled Payment

A payment arrangement for health care service providers based on a set amount for enrolled persons

assigned to them rather than a payment per service provided. The provider is paid whether or not the

enrolled person seeks care. - Ans:✔✔-Capitation

A payment system that measures the intensity of care and services required for each patient, and

translates these measures into the amount of reimbursement given to the facility for care of a patient.

Payment if linked to the intensity of resource use. - Ans:✔✔-Case Mix Reimbursement System

An electronic list of a facility's services and supplies, billing codes and the associated charges. The charge

master must be kept updated to the latest codes and government billing regulations for health claims. -

Ans:✔✔-Charge Master

A request for payment for the service(s) provided by a health care provider. - Ans:✔✔-Claim

The 1500 claim form is the universal insurance claim form developed and approved by the AMA and

Centers for Medicare and Medicaid Services. This form is used by non-institutional providers/suppliers to

bill Medicare carriers, commercial/private insurance and billing of some Medicaid State Agencies. -

Ans:✔✔-1500 Claim Form

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