Chapter 01: Health Insurance Specialist Career 1. If the insurance plan has a hold harmless clause, it means that the patient a. 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 OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and the parties involved. DATE CREATED: 12/11/2023 3:17 PM DATE MODIFIED: 12/11/2023 3:17 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 OBJECTIVES: UHI_GREEN_24_1.2 - Briefly summarize health insurance claims processing and the parties involved. DATE CREATED: 12/11/2023 3:17 PM DATE MODIFIED: 12/11/2023 3:17 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 the medical necessity of services/procedures.