Chapter 01: Health Insurance Specialist Career Page 1 Understanding Health Insurance 2022 17th Edition Green Test Bank 1. If the insurance plan has a hold harmless clause, it means that the patient is charged for fees by the health care provider, per the EOB. b. automatically has lower out-of-pocket health care expenses. c. is not responsible for paying what the insurance plan denies. d. was required to pay any amounts that the insurance plan denies. ANSWER: c POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIV UHI_GREEN_23_1.2 - Briefly summarize health insurance claims processing and the ES: parties involved. DATE CREATED: 10/3/2021 11:05 PM DATE MODIFIED: 10/3/2021 11:05 PM 2. The process of reporting as numeric and alphanumeric characters on the insurance claim is called coding. a. dates of service for procedures b. diagnoses and procedures/services c. health insurance claims identifiers d. national provider identifiers ANSWER: b POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIV UHI_GREEN_23_1.2 - Briefly summarize health insurance claims processing and the ES: parties involved. DATE CREATED: 10/3/2021 11:05 PM DATE MODIFIED: 10/3/2021 11:05 PM 3. A claims examiner employed by a third-party payer reviews health-related claims to determine whether the charges are reasonable, in addition to a assigning ICD-10-CM and CPT codes. . b. billing patients for copayments and coinsurance. c. determining medical necessity of services/procedures. d. resubmitting denied claims to health care providers. ANSWER: c POINTS: 1 QUESTION TYPEMultiple Choice : HAS VARIABLES False : Chapter 01: Health Insurance Specialist Career Page 2 Understanding Health Insurance 2022 17th Edition Green Test Bank LEARNING OBJEUHI_GREEN_23_1.2 - Briefly summarize health insurance claims processing and the CTIVES: parties involved. UHI_GREEN_23_1.3 - Identify career opportunities available for health insurance specialists. DATE CREATED:10/3/2021 11:05 PM DATE MODIFIED:10/3/2021 11:05 PM 4. Which is another name for a health insurance specialist? a. billing specialist b. coding specialist c. health information specialist d. reimbursement specialist ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVE S: UHI_GREEN_23_1.3 - Identify career opportunities available for health insurance specialists. DATE CREATED: 10/3/2021 11:05 PM DATE MODIFIED: 10/3/2021 11:05 PM 5. A claims examiner is employed by a a facility to submit claims. . b. governmental agency to process claims. c. physician’s office to submit claims. d. third-party payer to review claims. ANSWER: d POINTS: 1 QUESTION TYPE: Multiple Choice HAS VARIABLES: False LEARNING OBJECTIVE S: UHI_GREEN_23_1.3 - Identify career opportunities available for health insurance specialists. DATE CREATED: 10/3/2021 11:05 PM DATE MODIFIED: 10/3/2021 11:05 PM 6. Which involves linking every procedure or service code reported on the claim to a condition code that justifies the necessity of performing that procedure or service? a. claims adjudication b. diagnosis coding c. medical necessity d. reimbursement processing