FREE NCCT Health Insurance Claim Processing Questions and Answers

Question 1

Which form is used by a physician's office to submit claims for outpatient services?

Accepted Answer

CMS-1500

Answer

UB-04

Answer

Advance Beneficiary Notice (ABN)

Answer

Explanation of Benefits (EOB)

Question 2

What does the term 'adjudication' refer to in the health insurance claim process?

Accepted Answer

The insurance carrier's process of reviewing a claim and determining payment

Answer

The process of submitting a claim electronically

Answer

The initial patient registration and data entry

Answer

The process of appealing a denied claim

Question 3

A patient's insurance requires pre-authorization for an MRI. What is the primary purpose of this process?

Accepted Answer

To obtain approval from the insurance company for a service to be covered

Answer

To confirm the patient's demographic information is correct

Answer

To determine the patient's copayment amount

Answer

To bill the patient for the procedure before it is performed

Question 4

Which coding system is used to report medical procedures and services performed by physicians?

Accepted Answer

CPT (Current Procedural Terminology)

Answer

ICD-10-CM

Answer

HCPCS Level II

Answer

NDC (National Drug Code)

Question 5

A patient receives a document from their insurance company that details how a claim was processed, including the amount paid and the patient's financial responsibility. What is this document called?

Accepted Answer

Explanation of Benefits (EOB)

Answer

Superbill

Answer

Remittance Advice (RA)

Answer

CMS-1500

Question 6

In health insurance terminology, what is a 'deductible'?

Accepted Answer

A specified amount of money that the insured must pay before an insurance company will pay a claim

Answer

A fixed fee paid by the patient at the time of service

Answer

A percentage of the cost of a covered service that the patient is responsible for

Answer

The maximum amount a patient will have to pay out-of-pocket in a year

Question 7

When must a provider have a patient sign an Advance Beneficiary Notice of Noncoverage (ABN)?

Accepted Answer

When a provider believes a service may not be considered medically necessary by Medicare

Answer

Before any service is provided to a new Medicare patient

Answer

After a claim has been denied by Medicare

Answer

For all services billed to a secondary insurance carrier