HS215 UNIT 4 TEST REVIEW QUESTIONS .docx - HS215 Unit 4 Test Review 1 A health insurance claim is the documentation submitted to the patient requesting

HS215 UNIT 4 TEST REVIEW QUESTIONS .docx - HS215 Unit 4...

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HS215 Unit 4 Test Review 1. A health insurance claim is the documentation submitted to the patient requesting reimbursement for health care services provided. True 2. Health insurance specialists (or reimbursement specialists) review health-related claims to determine the medical necessity for procedures or services performed before reimbursement is made to the provider. True 3. The mutual exchange of data between the provider and insurance company is called electronic claims processing. False 4. A health care facility (or physician) that employs health insurance specialists is legally responsible for employees' actions performed within the context of their employment. This is called respondeat superior. True 5. The AAPC, AHIMA, and AMBA offer exams leading to professional credentials. True 6. The accurate coding of diagnoses, procedures, and services rendered to the patient allows a medical practice to communicate diagnostic and treatment data to a patient's insurance plan to assist the patient in obtaining maximum benefits. True 7. Fluency in the language of medicine and the ability to use a medical dictionary as a reference are not necessary skills for a health insurance specialist. False
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HS215 Unit 4 Test Review 8. To reduce coding and billing errors, health insurance specialists need to explain complex insurance concepts and regulations to patients and effectively communicate with providers regarding documentation of procedures and services. True 9. Coding is the process of reporting diagnoses, procedures, and services as numeric and alphanumeric characters on the explanation of benefits (EOB). False 10. Medical necessity involves linking every procedure or service code reported on the claim to an HCPCS code that justifies the necessity for performing that procedure or service. False 11. Liability insurance is a policy that covers losses to a third party caused by the insured. True 12. The primary intent of HIPAA is to provide better access to health insurance, limit fraud and abuse, and reduce administrative costs. True 13. The introduction of prepaid health plans was the forerunner of today's private insurance plans. False 14. A copayment is a provision in an insurance policy that requires
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