CMAA Review Question Preview (ID: 48944)


CMAA Review Over Insurance. TEACHERS: click here for quick copy question ID numbers.

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.

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

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.

Which is another name for a health insurance specialist?
a) billing specialist
b) coding specialist
c) health information specialist
d) reimbursement specialist

Which includes the identification of disease and the provision of care and treatment to persons who are sick, injured, or concerned about their health status?
a) health insurance
b) medical care
c) preventive care
d) third-party payment

Which may specifically result in the early detection of health problems, allowing less drastic and less expensive treatment options?
a) health care insurance
b) medical necessity
c) preventive examination
d) third-party payment

Which party signs a contract with a health insurance company and thus, owns the health insurance policy?
a) dependent
b) patient
c) payer
d) policyholder

Which provides health insurance coverage?
a) continuity of care
b) health insurance exchange
c) meaningful use
d) third-party payer

Which type of health insurance coverage is subsidized by employers and other organizations?
a) group health insurance
b) individual health insurance
c) public health insurance
d) universal health insurance

Which type of health insurance coverage has costs that are typically less per person and provides broader coverage?
a) group health insurance
b) individual health insurance
c) public health insurance
d) universal health insurance

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