Health Insurance and Medical Billing Practices Quiz

Test your understanding of health insurance and medical billing practices with these 16 quiz questions. Learn about COBRA, deductibles, EOB statements, and more.

Practice Learn Test

What does COBRA stand for in the context of health insurance?

Consolidated Omnibus Budget Reconciliation Act

Comprehensive Online Billing and Reimbursement Application

Coordination of Benefits and Reimbursement Act

Comprehensive Occupational Benefits and Reimbursement Agreement

Which of the following is NOT a typical component of a medical billing process?

Claims submission

Provider credentialing

Insurance verification

Medical diagnosis

Which government program provides health insurance coverage for individuals aged 65 and older in the United States?

Medicaid

CHIP

Medicare

VA Healthcare

In the United States, what does 'HIPAA' stand for in the context of healthcare?

Health Insurance Payment and Accountability Act

Healthcare Information Protection and Accountability Act

Health Insurance Portability and Accountability Act

Healthcare Information Privacy and Accountability Act

Which government program provides health insurance coverage for low-income individuals and families in the United States?

Medicare

Medicaid

CHIP

TRICARE

What is a 'premium' in the context of health insurance?

The amount a policyholder pays out of pocket before insurance coverage kicks in

The maximum amount of money the insurer will pay for covered services

The fee charged for services provided by healthcare professionals

The amount a policyholder pays to the insurance company for coverage

In health insurance, what does 'deductible' refer to?

The amount a policyholder pays out of pocket before insurance coverage kicks in

The maximum amount of money the insurer will pay for covered services

The fee charged for services provided by healthcare professionals

The portion of medical expenses that an insured person must pay after reaching a certain limit

What is the purpose of a 'Explanation of Benefits' (EOB) statement in medical billing?

To explain the benefits of a particular insurance plan to policyholders

To provide a summary of the medical services provided to the patient

To outline the costs and coverage details for healthcare services processed under the insurance plan

To list the qualifications and credentials of healthcare providers

What is the purpose of pre-authorization in health insurance?

To confirm a patient's eligibility for insurance coverage

To obtain approval from the insurance company before certain medical services or procedures are performed

To calculate the total out-of-pocket expenses for the patient

To verify the credentials of healthcare providers

#10

What is 'balance billing' in the context of medical expenses?

The process of billing multiple insurance companies for the same medical service

Billing patients for the difference between the provider's charge and the allowed amount by the insurance plan

A billing method used for long-term medical treatment

Billing insurance companies for medical services provided to patients

#11

What is the purpose of a CMS-1500 form in medical billing?

To request pre-authorization for medical procedures

To report medical services and procedures to insurance companies for reimbursement

To summarize a patient's medical history

To bill patients directly for medical services received

#12

What is a 'preferred provider organization' (PPO) in health insurance?

A network of healthcare providers who offer discounted rates to insurance companies

An organization that provides free healthcare services to low-income individuals

A type of health insurance plan that allows patients to see any healthcare provider without a referral

An organization that provides healthcare services exclusively to government employees

#13

What is the role of a Medical Coder in the healthcare industry?

To perform surgeries and medical procedures

To ensure medical facilities are clean and sanitized

To translate medical diagnoses and procedures into codes for billing and insurance purposes

To provide emotional support to patients and their families

#14

What is 'coordination of benefits' (COB) in health insurance?

The process of coordinating medical appointments for patients

The process of coordinating healthcare services with social services agencies

The process of determining which insurance plan pays first when a patient is covered by more than one insurance plan

The process of coordinating medical billing with pharmacy services

#15

What is the difference between 'coinsurance' and 'copayment' in health insurance?

Coinsurance is the percentage of covered healthcare costs the insured pays after the deductible, while copayment is a fixed amount the insured pays for covered services.

Coinsurance is the fixed amount the insured pays for covered services, while copayment is the percentage of covered healthcare costs the insured pays after the deductible.

Coinsurance is the amount the insured pays before insurance coverage kicks in, while copayment is the portion of medical expenses that an insured person must pay after reaching a certain limit.

Coinsurance is the maximum amount of money the insurer will pay for covered services, while copayment is the fee charged for services provided by healthcare professionals.

#16

What is 'utilization review' in the context of health insurance?

A process to determine the financial viability of healthcare providers

A process to review and approve the necessity and appropriateness of medical treatments and services

A process to negotiate rates between healthcare providers and insurance companies

A process to evaluate the performance of insurance agents