NHI Medical Office Procedures & Billing 3

Question 1

A Medicare patient is responsible for paying 20% of the Medicare-approved amount after the deductible. This payment is called a:

Accepted Answer

Coinsurance

Answer

Coinsurance is a percentage of the approved amount that the patient pays after meeting their deductible; Medicare Part B coinsurance is typically 20%.

Question 2

Which HIPAA standard transaction set is used for healthcare claim submission?

Accepted Answer

837

Answer

The HIPAA 837 transaction set is used for electronic submission of healthcare claims to payers.

Question 3

A medical office receives a payment from a secondary insurance payer. Which of the following should the biller do FIRST?

Accepted Answer

Verify the primary insurance payment was applied first

Answer

Before applying a secondary payment, the biller must confirm the primary insurance has already processed and paid the claim.

Question 4

What is the purpose of the National Provider Identifier (NPI)?

Accepted Answer

To uniquely identify healthcare providers in standard transactions

Answer

The NPI is a unique 10-digit identification number assigned to each covered healthcare provider for use in HIPAA standard transactions.

Question 5

A patient's balance after all insurance payments have been applied and adjustments made is called the:

Accepted Answer

Patient responsibility

Answer

Patient responsibility is the remaining amount owed by the patient after all insurance payments and contractual adjustments have been posted.

(NHI) National Healthcareer Institute Certification Practice Test

(NHI) National Healthcareer Institute Certification Practice Test

NHI Medical Office Procedures & Billing 3