#1
Which entity typically pays for healthcare services rendered to a patient?
The insurance company
ExplanationInsurance companies cover healthcare costs.
#2
What is the primary purpose of medical coding in healthcare billing?
To communicate diagnoses and procedures
ExplanationMedical coding communicates medical information for billing.
#3
What does the term 'EOB' stand for in healthcare billing?
Explanation of Benefits
ExplanationEOB explains covered benefits in an insurance plan.
#4
Which of the following is an example of a 'clean claim'?
A claim with all required information accurately filled out
ExplanationA clean claim has accurate and complete information.
#5
What is the purpose of a 'Claim Scrubber' in healthcare billing?
To ensure claims are error-free before submission
ExplanationClaim scrubbers check claims for errors before submission.
#6
Which coding system is primarily used for reporting inpatient procedures in the United States?
ICD-10-PCS
ExplanationICD-10-PCS codes report inpatient procedures.
#7
What does the acronym 'CMS' stand for in the context of healthcare billing and reimbursement?
Centers for Medicare & Medicaid Services
ExplanationCMS oversees Medicare and Medicaid services.
#8
In the United States, what is the primary code set used for medical billing and reimbursement?
CPT
ExplanationCPT codes are used for medical billing.
#9
What is the purpose of a 'Remittance Advice' in healthcare billing?
To notify providers of denied claims
ExplanationRemittance advice notifies providers of denied claims.
#10
What is the role of a 'Clearinghouse' in healthcare billing?
To process insurance claims electronically
ExplanationClearinghouses process electronic insurance claims.
#11
What is the purpose of the 'National Provider Identifier (NPI)'?
To identify healthcare providers in electronic transactions
ExplanationNPI identifies healthcare providers electronically.
#12
What is the purpose of a 'Prior Authorization' requirement in healthcare billing?
To obtain approval from the insurance company before certain services are rendered
ExplanationPrior authorization ensures approval before certain services.
#13
Which of the following is NOT typically a factor in determining reimbursement rates for healthcare services?
Patient's age
ExplanationPatient's age isn't typically a factor in reimbursement rates.
#14
Which government program provides healthcare coverage for individuals aged 65 and older in the United States?
Medicare
ExplanationMedicare provides coverage for seniors.
#15
What is the purpose of a 'UB-04' form in healthcare billing?
To report inpatient services
ExplanationUB-04 form reports inpatient services.
#16
Which government agency oversees the regulation and enforcement of the Affordable Care Act (ACA) in the United States?
Department of Health and Human Services (HHS)
ExplanationHHS oversees ACA regulation and enforcement.
#17
What is the purpose of the 'Explanation of Benefits (EOB)' statement sent to patients?
To explain the benefits covered by their insurance plan
ExplanationEOB explains insurance plan benefits to patients.