Question 1

Appeals generally must be in writing and initiated within ___________ days.

Accepted Answer

A)   10 to 20
B)   30 to 60
C)   60 to 90
D)   360E) A) and B)
F) C) and D)

Question 2

EOBs can be submitted only in electronic format.

Accepted Answer

A) True 
 B)False

Question 3

Services that usually require preauthorization or precertification include:

Accepted Answer

A)   laboratory tests.
B)   emergency room services.
C)   routine "wellness" examinations.
D)   inpatient hospitalization.E) None of the above
F) B) and C)

Question 4

Providers cannot waive Medicare copayments unless ____________ has been established and documented.

Accepted Answer

A)   legitimate financial hardship
B)   a secondary insurer
C)   coordination of benefits
D)   adjudicationE) B) and D)
F) A) and B)

Question 5

List the six keys to successful claims processing.

Accepted Answer

Verifying patient information
Obtaining ...

Question 6

If a patient is incapacitated in any way,the health insurance professional is not allowed (by law)to contact the patient's insurer to obtain preauthorization.

Accepted Answer

A) True 
 B)False

Question 7

Insurance companies usually have no time limits for filing appeals.

Accepted Answer

A) True 
 B)False

Question 8

A suspension file is a series of files set up alphabetically and labeled according to the number of days since the claim was submitted.

Accepted Answer

A) True 
 B)False

Question 9

It is the patient's responsibility to document nonmedical comments in his or her own health record.

Accepted Answer

A) True 
 B)False

Question 10

List at least 4 ways for optimizing the billing and claims process.

Accepted Answer

Create a consistent scheduling...

Question 11

If there is a second insurance policy,it is important to check "yes" in Block ____________ on the CMS-1500 form and complete Blocks 9,9a,and 9d.

Accepted Answer

A)   9a
B)   10c
C)   11d
D)   21E) A) and C)
F) A) and B)

Question 12

When a patient signs an assignment of benefits,he or she is authorizing the insurance carrier to send payment directly to the healthcare provider.

Accepted Answer

A) True 
 B)False

Question 13

To complete the entire claims process,a paper claim normally takes:

Accepted Answer

A)   4 to 6 weeks.
B)   4 to 6 days.
C)   4 to 6 months.
D)   up to 1 year.E) A) and B)
F) A) and C)

Question 14

What are the basic rules for appealing a claim?

Accepted Answer

Basic rules for appealing a claim are
(...

Question 15

The Medicare program has a multileveled appeal process.How many levels are there?

Accepted Answer

A)   three
B)   four
C)   five
D)   sixE) A) and B)
F) B) and D)

Question 16

If a health insurance professional discovers an error in a claim that could result,or already has resulted,in inaccurate reimbursement,what should be done?

Accepted Answer

Unless the health insurance professional...

Question 17

Correct code initiative edits are the result of the National Correct Coding Initiative.

Accepted Answer

A) True 
 B)False

Question 18

Only the provider has the right to appeal a rejected claim.

Accepted Answer

A) True 
 B)False

Question 19

The type of Medicare coverage dictates the specific appeal filing process.

Accepted Answer

A) True 
 B)False

Question 20

After the patient information form is completed,the health insurance professional should check it over to ensure the information is complete and legible.

Accepted Answer

A) True 
 B)False

Exam 15: Keys to Successful Claims Management

What are the basic rules for appealing a claim?

Correct AnswerverifiedBasic rules for appealing a claim are (...View AnswerShow Answer

List at least 4 ways for optimizing the billing and claims process.

Correct AnswerverifiedCreate a consistent scheduling...View AnswerShow Answer

Appeals generally must be in writing and initiated within ___________ days.

Correct AnswerverifiedShow Answer

If a health insurance professional discovers an error in a claim that could result,or already has resulted,in inaccurate reimbursement,what should be done?

Correct AnswerverifiedUnless the health insurance professional...View AnswerShow Answer

Only the provider has the right to appeal a rejected claim.

Correct AnswerverifiedShow Answer

If a patient is incapacitated in any way,the health insurance professional is not allowed (by law)to contact the patient's insurer to obtain preauthorization.

Correct AnswerverifiedShow Answer

Services that usually require preauthorization or precertification include:

Correct AnswerverifiedShow Answer

It is the patient's responsibility to document nonmedical comments in his or her own health record.

Correct AnswerverifiedShow Answer

To complete the entire claims process,a paper claim normally takes:

Correct AnswerverifiedShow Answer

The type of Medicare coverage dictates the specific appeal filing process.

Correct AnswerverifiedShow Answer

A suspension file is a series of files set up alphabetically and labeled according to the number of days since the claim was submitted.

Correct AnswerverifiedShow Answer

If there is a second insurance policy,it is important to check "yes" in Block ____________ on the CMS-1500 form and complete Blocks 9,9a,and 9d.

Correct AnswerverifiedShow Answer

Insurance companies usually have no time limits for filing appeals.

Correct AnswerverifiedShow Answer

EOBs can be submitted only in electronic format.

Correct AnswerverifiedShow Answer

List the six keys to successful claims processing.

Correct AnswerverifiedVerifying patient informationObtaining ...View AnswerShow Answer

After the patient information form is completed,the health insurance professional should check it over to ensure the information is complete and legible.

Correct AnswerverifiedShow Answer

The Medicare program has a multileveled appeal process.How many levels are there?

Correct AnswerverifiedShow Answer

When a patient signs an assignment of benefits,he or she is authorizing the insurance carrier to send payment directly to the healthcare provider.

Correct AnswerverifiedShow Answer

Correct code initiative edits are the result of the National Correct Coding Initiative.

Correct AnswerverifiedShow Answer

Providers cannot waive Medicare copayments unless ____________ has been established and documented.

Correct AnswerverifiedShow Answer

Correct Answer
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Basic rules for appealing a claim are
(...
View Answer

Correct Answer
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Create a consistent scheduling...
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Correct Answer
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Unless the health insurance professional...
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Correct Answer
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Correct Answer
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Correct Answer
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Correct Answer
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Correct Answer
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Correct Answer
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Correct Answer
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Correct Answer
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Correct Answer
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Correct Answer
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Correct Answer
verified
Verifying patient information
Obtaining ...
View Answer

Correct Answer
verified

Correct Answer
verified

Correct Answer
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Correct Answer
verified

Correct Answer
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