TABLE OF CONTENTS Review............................................................................................................................ 1 1.1: Multiple Choice ..................................................................................................... 1 1.2: Professionalism................................................................................................... 16 REVIEW 1.1: MULTIPLE CHOICE 1. The document submitted to the payer requesting reimbursement is called a(n) a. explanation of benefits (EOB). b. health insurance claim. c. remittance advice. d. prior approval form. ANS: b Analysis: a. Incorrect. The patient receives an explanation of benefits (EOB) from the third-party payer, which is a report detailing the results of processing a claim. A health insurance claim is the documentation submitted to a thirdparty payer or government program requesting reimbursement for the health care services provided. b. Correct. A health insurance claim is the documentation submitted to a third-party payer or government program requesting reimbursement for the health care services provided. c. Incorrect. The provider receives a remittance advice (or remit), a notice that is sent by the insurance company that contains payment information about a claim. A health insurance claim is the documentation submitted to a third-party payer or government program requesting reimbursement for the health care services provided. d. Incorrect. Many health insurance plans and programs require prior approval for treatment by specialists and documentation of post-treatment reports, and if the prior approval form is not submitted prior to treatment, payment of the claim is denied. A health insurance claim is the documentation submitted to a third-party payer or government program