Module 2 Insurance Eligibility and Other
Payer Requirements (NHA)
1. A billing and coding professional is calculating a affected person's economic duty for a
manner. The rate for the for the process is $1,400 and the issuer is within the affected
person's coverage provider's network. The allowable amount for the procedure is $500
with out a deductible required. If the insurance plan will pay at 80/20, what s the patient's
overall coinsurance quantity? - ANS-$100
2. A billing and coding expert is getting ready a claim for a 16-yar-old affected person. Who
have to be contacted to verify the kid's demographics? - ANS-Policyholder
3. A billing and coding expert is preparing a claim for a sixty nine-year-vintage patient who
become involved in a motor-car crash. The professional have to post the primary declare
to which 1/3-celebration payer? - ANS-Auto Insurance
4. A billing and coding specialist is preparing the registration for a patient who's protected
beneath their partner's insurance. What is required to complete the registration? -
ANS-Patient Demographics
5. A billing and coding expert is reviewing a patient's insurance coverage and notices that
the patient is blanketed by institution insurance plans: one through their personal
enterprise and one thru their companion's agency. The expert have to understand that
which of the subsequent is genuine regarding the purchaser's primary insurance
coverage? - ANS-Primary Coverage is furnished through the affected person's plan
6. A billing and coding professional is reviewing a affected person's report. The
professional have to apprehend that which of the subsequent ought to be signed by
using the affected person if there's a challenge that Medicare may not pay for the
provider? - ANS-Advanced Beneficiary Notice (ABN)
7. A billing and coding professional is reviewing coverage eligibility for a forty
nine-yr-antique patient who has end-level renal disease and more than one third-party
payers. The expert need to recognize that what payer is the number one? -
ANS-Medicare
8. A billing and coding professional is speakme with a patient on the phone regarding the
constant quantity due for an upcoming visit. What term refers to a set fee due in line with
go to? - ANS-Copayment
9. A billing and coding expert is submitting a claim for a affected person who experienced
an injury from a fall all through their lunch wreck far from the constructing. The specialist
should understand which primary payer for the claim? - ANS-The patient's organization
medical health insurance
10. A toddler's parents have fitness coverage on the kid, and there may be a court order
pointing out the daddy is answerable for the kid's health care.According to the birthday
rule, whose coverage might be primary? - ANS-Father
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