Exam (elaborations)
(ME2550) Healthcare Settings, Claim Cycle, and Claims Processing Week_2_Chapter_4.1_Quiz
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(ME2550) Healthcare Settings, Claim Cycle, and Claims Processing
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1. A nonparticipating provider:a. is eligible to receive health care benefits.
b. pays the bill for health care services.
c. contracts with the insurance plan.
d. does not contract with the insurance plan.
2. The primary insurance is:
a. based on the later birth date of the parent.
b. responsible for paying the health insurance claim first.
c. always determined by third-party administrators.
d. in the mother’s name for a child
3. The birthday rule is used to determine the:
a. birthday of the dependent child
b. coinsurance amount
c. date to pay a claim
d. primary and secondary policyholders
4. The last resort of a medical practice to recover payment for a debt for providing health care services is:
a. suspension
b. appeal
c. litigation
d. collection
5. The process of comparing a claim to payer edits and the patient’s health plan benefits for verification is called
claims:
a. processing
b. attachment
c. adjudication
d. submission
6. The transmission of claims data to payers or clearinghouses for processing is called claims:
a. submission
b. adjudication
c. processing
d. attachment
7. A medical condition that was diagnosed, treated, or both within a specified period of time immediately
preceding the enrollee’s effective date of coverage is called a(n):
a. covered entity
b. pre-existing condition
c. noncovered benefit
d. unauthorized service
8. The amount owed to a business for services or goods provided is called the:
a. accounts receivable
b. allowed charges
c. superbill
d. deductible
9. The accounts receivable aging report:
a. contains the same information as a paper-based remittance advice
b. shows the status (by date) of outstanding claims from each payer, as well as payments due from patients
c. includes a chronological summary of all transactions posted to individual patient ledgers/accounts on a specific
day
d. contains a computer-generated list of procedures, services, and supplies with charges for each
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