Healthcare Insurance Test Questions
Chapters 1 & 2
120 points possible (3 pts ea)
A. List 5 developments in Health Care by year 1. claim processing
2. billing regulations
3.posses accurate coding skills
4. ability to successfully appeal underpaid or denied insurance claims
5.demonstrates workplace professionalism are in demand
B. List 5 career opportunities for a health insurance reimbursement specialist 1. health insurance specialist
2.claim examiner
3.medical necessity
4. medical assistant
5.coding
C. List 10 skills of an insurance billing specialist
1. Communication
2. Conflict management
3. Customer service
4. Diversity awareness
5. leadership
6. managing change
7. productivity
8. professionalism ethics
9. team building
10. telephone skills for the health care setting
D. Define the following terms
1. Health Insurance- reviews health-related claims to determine the medical necessity for procedures or services performed before payment is made to the provider.
2. Claims examiner- employed by third party payer reviews health related claims to determine whether the charges are reasonable and for medical necessity.
3. Electronic Health Record- global concept that includes the collection of patient information documented by a number of providers at different facilities regarding one patient
4. SOAP- Subjective, objective, assessment, plan
5. Medical Necessity- codes that are used to preform the procedure or service
E. Name the 3 functions of the electronic medical record
1. includes a patients medication lists, problems, clinic notes and other documentations.
2. Allows providers to prescribe medication as well as order and view results of ancillary tests.
3. Alerts the provider about drug interactions abnormal ancillary testing results and when ancillary tests are needed
F. List 2 of the 3 categories of the problem-oriented problem list
1. Diagnostic/ management plans
2. Therapeutic plans
I. List 5 training requirements for the insurance specialist 1. Anatomy and Physiology,
120 points possible (3 pts ea)
A. List 5 developments in Health Care by year 1. claim processing
2. billing regulations
3.posses accurate coding skills
4. ability to successfully appeal underpaid or denied insurance claims
5.demonstrates workplace professionalism are in demand
B. List 5 career opportunities for a health insurance reimbursement specialist 1. health insurance specialist
2.claim examiner
3.medical necessity
4. medical assistant
5.coding
C. List 10 skills of an insurance billing specialist
1. Communication
2. Conflict management
3. Customer service
4. Diversity awareness
5. leadership
6. managing change
7. productivity
8. professionalism ethics
9. team building
10. telephone skills for the health care setting
D. Define the following terms
1. Health Insurance- reviews health-related claims to determine the medical necessity for procedures or services performed before payment is made to the provider.
2. Claims examiner- employed by third party payer reviews health related claims to determine whether the charges are reasonable and for medical necessity.
3. Electronic Health Record- global concept that includes the collection of patient information documented by a number of providers at different facilities regarding one patient
4. SOAP- Subjective, objective, assessment, plan
5. Medical Necessity- codes that are used to preform the procedure or service
E. Name the 3 functions of the electronic medical record
1. includes a patients medication lists, problems, clinic notes and other documentations.
2. Allows providers to prescribe medication as well as order and view results of ancillary tests.
3. Alerts the provider about drug interactions abnormal ancillary testing results and when ancillary tests are needed
F. List 2 of the 3 categories of the problem-oriented problem list
1. Diagnostic/ management plans
2. Therapeutic plans
I. List 5 training requirements for the insurance specialist 1. Anatomy and Physiology,