7/19/23, 4:23 PM Toll Gate – 01 Assessment (Effective April ‘21)

Dashboard / My courses / AR - New / Day 10 / Toll Gate – 01 Assessment (Effective April ‘21)

Started on Tuesday, 18 July 2023, 9:58 PM

State Finished
Completed on Tuesday, 18 July 2023, 10:52 PM
Time taken 53 mins 59 secs
Marks 68/80
Grade 85 out of 100

Question 1

Correct

Mark 1 out of 1

___________ Department is responsible to obtain the maximum and timely reimbursement for
the claims submitted.

Select one:
a. Financial counselling

b. Charge entry

c. Patient registration

d. Accounts Receivables 

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7/19/23, 4:23 PM Toll Gate – 01 Assessment (Effective April ‘21)

Question 2

Incorrect

Mark 0 out of 1

ESRD is an eligibility criterion for

Select one:
a. Medicare and Managed care

b. Medicare and Medicaid 

c. Medicaid

d. Medicare

Question 3

Incorrect

Mark 0 out of 1

What is a Contractual adjustment?

Select one:
a. It is a percentage of the charge or the dollar amount that the patient will pay to the
provider for every encounter or visit 

b. It is the denial of the claim.

c. It is the difference between the actual fee and the permitted fee

d. It is the on-going fee paid to the insurance company by the insured

Question 4

Correct

Mark 1 out of 1

__________ is a plan given by BCBS for government employees.

Select one:
a. Individual health plan

b. Blue Card Plan

c. Indemnity plan

d. BCBS Federal plan 

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7/19/23, 4:23 PM Toll Gate – 01 Assessment (Effective April ‘21)

Question 5

Correct

Mark 1 out of 1

Which of the following is not a term used to describe a person who is covered by an insurance
policy?

Select one:
a. Subscriber

b. Policyholder

c. Provider 

d. Insured

Question 6

Correct

Mark 1 out of 1

A provider that contracts with the health insurance plan and agrees to accept whatever the plan
pays for the procedures and services performed is known as a

Select one:
a. Par Provider 

b. Non-par Provider

c. Primary Care Physician

d. Specialty Care Physician

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7/19/23, 4:23 PM Toll Gate – 01 Assessment (Effective April ‘21)

Question 7

Correct

Mark 1 out of 1

A type of cost sharing where the beneficiary and the carrier share payment of the allowed
charge for covered services.

Select one:
a. Co-Payment

b. Co-Insurance 

c. Premium

d. Deductible

Question 8

Correct

Mark 1 out of 1

Arrange the following: 

1. Accounts Receivables 
2. EOB 
3. Collection Agency 
4. Insurance Company
5. Claim form creation
6. Clearing House 
7. Medical Coding 
8. Medical Transcription
9. Pre-Registration 
10. Encounter

Select one:
a. 9,10,8,7,5,6,4,2,1,3 

b. 10,9,8,7,5,6,4,2,1,3

c. 9,10,7,8,5,6,4,2,1,3

d. 9,10,8,7,5,6,4,3,1,2

e. None of the above

Your answer is correct.

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7/19/23, 4:23 PM Toll Gate – 01 Assessment (Effective April ‘21)

Question 9

Incorrect

Mark 0 out of 1

The fixed amount an insured person is expected to pay to the provider at the time of the service

Select one:
a. Premium

b. Co-Insurance

c. Deductible 

d. Co-Payment

Question 10

Correct

Mark 1 out of 1

Which one of the following is a provider?

Select one:
a. Ward boy

b. Therapist 

c. None of the above

d. Patient attender

Question 11

Correct

Mark 1 out of 1

The process of transforming descriptions of medical diagnoses and procedures into universal
medical code numbers,

Select one:
a. Charge entry

b. Medical transcription

c. Medical coding 

d. Payment posting

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7/19/23, 4:23 PM Toll Gate – 01 Assessment (Effective April ‘21)

Question 12

Correct

Mark 1 out of 1

Clearinghouse does __________ the electronic claims received from the Provider.

Select one:
a. Processing & Adjudicating

b. Adjudicating & Transmission

c. Preliminary screening & Transmission 

d. All the listed options

Question 13

Correct

Mark 1 out of 1

Clearing house is an entity that helps in transmitting claims along with attachments
electronically to the insurance company.

Select one:
a. False 

b. True

Question 14

Correct

Mark 1 out of 1

Which of the following does the acronym HIPAA stand for?

Select one:
a. Health Insurance Portability and Administrative Act of 1995

b. Health Insurance Portability, Accountability and Administrative Act of 1995

c. Health Insurance Program and Accountability Act of 1996

d. Health Insurance Portability and Accountability Act of 1996 

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7/19/23, 4:23 PM Toll Gate – 01 Assessment (Effective April ‘21)

Question 15

Correct

Mark 1 out of 1

An Adjustor is a person found in

Select one:
a. Medicare

b. Workers Compensation 

c. Medicaid

d. CHAMPVA

e. Tricare

Question 16

Correct

Mark 1 out of 1

A Non Participating Provider's claims get paid by the following method.

Select one:
a. Fee Schedule

b. Case Rate

c. Per Diem

d. Capitation

e. Usual, Customary and Reasonable rate 

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7/19/23, 4:23 PM Toll Gate – 01 Assessment (Effective April ‘21)

Question 17

Correct

Mark 1 out of 1

Someone who is eligible for or receiving benefits under an insurance policy or plan

Select one:
a. Beneficiary 

b. Referring individual

c. Standard

d. Supplier

Question 18

Incorrect

Mark 0 out of 1

Demo Entry gets information from,

Select one:
a. All the listed options

b. Hospital system

c. Patient demographic form

d. Patient registration form 

Question 19

Correct

Mark 1 out of 1

If a patient has both Medicaid and Medicare

Select one:
a. Medicaid is primary

b. Medicaid is secondary 

c. Medicaid does not pay

d. Medicare does not pay

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7/19/23, 4:23 PM Toll Gate – 01 Assessment (Effective April ‘21)

Question 20

Correct

Mark 1 out of 1

Patient Responsibility (Pts Resp) + Payment Amount (Pd. Amt) ________________

Select one:
a. None of the above

b. Charge amount

c. Contractual adjustment

d. Allowed amount 

Question 21

Correct

Mark 1 out of 1

The carrier sends this notice to the patient and Doctor after processing the claim; it tells if the
claim was paid or denied.

Select one:
a. EOC

b. AOB

c. ABN

d. COB

e. EOB 

Question 22

Correct

Mark 1 out of 1

A Co-payment is a fixed dollar amount during the benefit period that an insured person pays
before the insurer starts to make payments for covered medical services.

Select one:
a. True

b. False 

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7/19/23, 4:23 PM Toll Gate – 01 Assessment (Effective April ‘21)

Question 23

Correct

Mark 1 out of 1

Dual eligibility means that patient is eligible with both

Select one:
a. Medicaid and Medigap

b. Medicare and Medigap

c. Medicare and Medicaid 

d. Medicare and Managed care

Question 24

Correct

Mark 1 out of 1

Medicaid is termed as

Select one:
a. Payor of lost resort

b. Medicaid managed care

c. Payer of last resort 

d. Commercial insurance

Question 25

Correct

Mark 1 out of 1

The standard office visit fee for a procedure is $1400.00; your physician is contracted with ABC
insurance and the fee schedule is $1275.00, what would the contractual adjustment be?

Select one:
a. $1120.00

b. $500.00

c. $125.00 

d. $280.00

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7/19/23, 4:23 PM Toll Gate – 01 Assessment (Effective April ‘21)

Question 26

Correct

Mark 1 out of 1

Billed amount is $100.00; Primary Allowed amount is $70.00 and if primary pays 80% what will
be the coinsurance amount?

Select one:
a. $8.00

b. 16.00

c. $14.00 

d. $10.00

Question 27

Incorrect

Mark 0 out of 1

I have to pay deductible to keep my policy active

Select one:
a. False

b. True 

Question 28

Correct

Mark 1 out of 1

The functions of a medical billing office are,

Select one:
a. Getting information from the provider

b. All the listed options 

c. Collects payment from the insurance on behalf of the provider

d. Submits claims to the insurance

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7/19/23, 4:23 PM Toll Gate – 01 Assessment (Effective April ‘21)

Question 29

Correct

Mark 1 out of 1

Patients who stay overnight in the hospital are considered to be

Select one:
a. Same Day patients

b. Long term patients

c. In patients 

d. Out patients

Question 30

Correct

Mark 1 out of 1

A person who is 65 years and above is covered under which payer?

Select one:
a. Tricare

b. BCBS

c. Medicaid

d. Medicare 

Question 31

Correct

Mark 1 out of 1

What is HIPAA?

Select one:
a. Standardization of electronic health transactions

b. All the listed options 

c. Privacy protection of individual health information

d. Security of health information for patient

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7/19/23, 4:23 PM Toll Gate – 01 Assessment (Effective April ‘21)

Question 32

Correct

Mark 1 out of 1

This is the process by which the doctor can object if he/she disagrees with the carriers decision
to not to pay for the service.

Select one:
a. TAR

b. Out of network

c. Appeal 

d. Consent form

Question 33

Correct

Mark 1 out of 1

ABN is to be signed by the patient

Select one:
a. By all Medicare patients

b. Every time before treatment

c. By all patients, when treatment will not be covered

d. By Medicare patients, when treatment may not be covered 

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7/19/23, 4:23 PM Toll Gate – 01 Assessment (Effective April ‘21)

Question 34

Correct

Mark 1 out of 1

A form signed by the policy holder asking Insurance Company to directly pay money to the
provider

Select one:
a. COB

b. ROI

c. AOB 

d. ABN

Question 35

Incorrect

Mark 0 out of 1

A patient who stayed at the hospital for 12 hours is considered as

Select one:
a. IP 

b. SDS

c. DS

d. OP

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7/19/23, 4:23 PM Toll Gate – 01 Assessment (Effective April ‘21)

Question 36

Correct

Mark 1 out of 1

Insurance sends __________________ to the patients and Providers once they process the
claim.

Select one:
a. ABN

b. EOB 

c. AOB

d. ROI

e. COB

Question 37

Correct

Mark 1 out of 1

The main objective of a billing company is to maximize collections

Select one:
a. True 

b. False

Question 38

Correct

Mark 1 out of 1

____________________ tells when the patient was treated.

Select one:
a. Date of visit

b. Date of submission

c. Date of service 

d. Date of injury

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7/19/23, 4:23 PM Toll Gate – 01 Assessment (Effective April ‘21)

Question 39

Correct

Mark 1 out of 1

Expansion for TIN is

Select one:
a. Tax Insurance Number

b. Tax Identifier Number

c. Tax Identification Number 

d. None of the listed options

Question 40

Correct

Mark 1 out of 1

National Provider Identifier (NPI) is a single block of nine characters.

Select one:
a. True

b. False 

Question 41

Correct

Mark 1 out of 1

To indicate a change or alteration in the treatment, a provider would bill with a

Select one:
a. Modifier 

b. HCPCS

c. CPT

d. DX

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7/19/23, 4:23 PM Toll Gate – 01 Assessment (Effective April ‘21)

Question 42

Correct

Mark 1 out of 1

An identification number for providers mandated by HIPAA

Select one:
a. UPIN

b. NPI 

c. PIN

d. TIN

Question 43

Correct

Mark 1 out of 1

A number given by doctor or hospital at the time of registration

Select one:
a. Medical Record Number 

b. Authorization Number

c. Account number

d. Referral Number

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7/19/23, 4:23 PM Toll Gate – 01 Assessment (Effective April ‘21)

Question 44

Incorrect

Mark 0 out of 1

If the doctor is a Participating Provider, what does this mean?

Select one:
a. Physician will accept the amount paid by the insurance company and will take an
adjustment for the non-allowed amount

b. The physician can charge what they feel is reasonable and customary for their
geographical location and will be paid 100% of their fee 

c. None listed

d. The payment goes to the patient and the doctor must bill the patient for any services
rendered

Question 45

Correct

Mark 1 out of 1

_________ is a process in which the payer examines the claims received from the Provider and
makes a decision.

Select one:
a. Claims Creation

b. Claims Preparation

c. Claims adjudication 

d. Claims Transmission

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7/19/23, 4:23 PM Toll Gate – 01 Assessment (Effective April ‘21)

Question 46

Correct

Mark 1 out of 1

A deductible is a form of cost sharing in a health plan that requires the insured to pay a
percentage of medical expenses.

Select one:
a. False 

b. True

Question 47

Incorrect

Mark 0 out of 1

To misuse a person or services in a way that harm caused is considered as ___________.

Select one:
a. None of the above

b. Abuse

c. Waste

d. Fraud 

Question 48

Correct

Mark 1 out of 1

______________ covers the spouse / child of a veteran who has rated permanently disabled for
a service connected disability.

Select one:
a. BCBS

b. CHAMPVA 

c. Medicare

d. CHAMPUS

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7/19/23, 4:23 PM Toll Gate – 01 Assessment (Effective April ‘21)

Question 49

Correct

Mark 1 out of 1

The type of payment where both technical charges and professional charges are paid together
is

Select one:
a. UCR

b. Per Diem

c. Bundled 

d. Case rate

e. Capitation

Question 50

Correct

Mark 1 out of 1

The process used by carriers to examine and verify the medical qualifications of providers who
want to participate with them.

Select one:
a. Out of network

b. None of the above

c. Provider access

d. Credentialing 

e. In-Network

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7/19/23, 4:23 PM Toll Gate – 01 Assessment (Effective April ‘21)

Question 51

Correct

Mark 1 out of 1

Find the CPT code among the following

Select one:
a. 99802 

b. J1020

c. 123 58 4386

d. A82.75

Question 52

Correct

Mark 1 out of 1

A number given by the Insurance Company to the contracted providers.

Select one:
a. PIN 

b. NPI

c. Taxonomy

d. TIN

Question 53

Correct

Mark 1 out of 1

Which block has referring providers NPI number?

Select one:
a. 17a

b. 33a

c. 17b 

d. 33b

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7/19/23, 4:23 PM Toll Gate – 01 Assessment (Effective April ‘21)

Question 54

Correct

Mark 1 out of 1

The provider must get this number before he can give treatment to the patient.

Select one:
a. Visit ID number

b. Claim number

c. Medical Record Number

d. Authorization number 

Question 55

Correct

Mark 1 out of 1

CPT codes are used to report services rendered by physicians

Select one:
a. False

b. True 

Question 56

Correct

Mark 1 out of 1

The maximum amount that an insurance company deems fair to allow on a procedure

Select one:
a. Excluded

b. Allowed amount 

c. Co-Insurance

d. Non-Covered Services

e. Co-Pay

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7/19/23, 4:23 PM Toll Gate – 01 Assessment (Effective April ‘21)

Question 57

Correct

Mark 1 out of 1

The other names for providers are,

Select one:
a. Doctors, Payers, Healthcare Professionals, Medical providers

b. Physicians, Healthcare Professionals, Pleaders, Medical providers

c. Doctors, Healthcare Professionals, Medical providers, Patients

d. Doctors, Physicians, Healthcare Professionals, Medical providers 

Question 58

Correct

Mark 1 out of 1

The carrier will process the claim towards ___________ to a subsequent claim when they made
an excess payment to the provider.

Select one:
a. Offset 

b. Recoupment

c. Refund

d. Refile

Question 59

Correct

Mark 1 out of 1

AR is a process of

Select one:
a. All the listed options 

b. Understand why the payment has not been made

c. Take necessary steps to resolve the claim and fasten the payment

d. Reviewing the claims submitted to insurance

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7/19/23, 4:23 PM Toll Gate – 01 Assessment (Effective April ‘21)

Question 60

Correct

Mark 1 out of 1

Self-pay means

Select one:
a. Coordination of benefits

b. Pt pays for dependents thru insurance

c. Pt pays for own self and has insurance

d. Pt pays for own self and has no insurance 

Question 61

Correct

Mark 1 out of 1

The fixed payments paid to the provider on a monthly basis for each patient assigned to that
doctor as a PCP by the carrier.

Select one:
a. UCR

b. Per Diem

c. Case rate

d. Capitation 

e. Bundled

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Question 62

Correct

Mark 1 out of 1

The period that carriers give to providers to submit claims and be reimbursed is called
_______________.

Select one:
a. Appeals limit

b. Corrected claim filing

c. Claim limit

d. Timely Filing limit 

e. Resubmission limit

Question 63

Correct

Mark 1 out of 1

Scrubber report or EDI report is generated by

Select one:
a. Provider

b. Medical Billing Company

c. Payer

d. Clearing house 

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Question 64

Correct

Mark 1 out of 1

In ____________, claims have has to be submitted along with ________.

Select one:
a. None of the above options

b. Medicaid & Medical Records

c. Workmen's Compensation & Medical Records 

d. Workmen's Compensation & POTF

e. Medicare & Supporting documents

Question 65

Correct

Mark 1 out of 1

Medicaid ID format is state specific.

Select one:
a. True 

b. False

Question 66

Incorrect

Mark 0 out of 1

A PCP role is not found in this plan.

Select one:
a. LGHP 

b. PPO

c. POS

d. HMO

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Question 67

Correct

Mark 1 out of 1

A PCP must be specialized in a certain field of medicine

Select one:
a. True

b. False 

Question 68

Correct

Mark 1 out of 1

Medicare part A covers

Select one:
a. None of the above

b. Dental Claims

c. Outpatient Claims

d. Inpatient Claims 

Question 69

Correct

Mark 1 out of 1

Physician services are billed on ____________ claim form.

Select one:
a. None of the listed options

b. CMS 1500 

c. UB 92

d. UB 04

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Question 70

Correct

Mark 1 out of 1

When a PCP wants to refer a patient to a specialist, the patient must collect
________________

Select one:
a. None of the listed options

b. Referral number 

c. Pre-approved number

d. Pre certification number

e. Authorization number

Question 71

Correct

Mark 1 out of 1

The details of the patient are collected during,

Select one:
a. Charge entry

b. Pre-registration 

c. Encounter

d. Demo entry

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7/19/23, 4:23 PM Toll Gate – 01 Assessment (Effective April ‘21)

Question 72

Correct

Mark 1 out of 1

Mr. Brown has an insurance plan with a deductible balance of $300.00 until date and his
provider sends a claim to the insurance worth $200.00; how much insurance would pay for the
claim?

Select one:
a. $100.00

b. $150.00

c. $0.00 

d. $200.00

Question 73

Correct

Mark 1 out of 1

In which block do you find the Release of Information (ROI)?

Select one:
a. 17

b. 13

c. 10

d. 12 

e. 27

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7/19/23, 4:23 PM Toll Gate – 01 Assessment (Effective April ‘21)

Question 74

Correct

Mark 1 out of 1

A facility where terminally ill patients are taken care is called

Select one:
a. Outpatient clinics

b. Hospice 

c. Home Health

d. SNF

Question 75

Correct

Mark 1 out of 1

Abbreviate DHHS

Select one:
a. Department of Health & Humanity Services

b. None of the above

c. Department of Health & Human Server

d. Department of Health & Human Services 

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7/19/23, 4:23 PM Toll Gate – 01 Assessment (Effective April ‘21)

Question 76

Correct

Mark 1 out of 1

What is an EOB?

Select one:
a. A report with details the results of processing a claim is called Explanation of Benefits

b. A external review organization that reviews claims after processing for medical
necessity or called External Overview Billing organization

c. A managed care plan the provide benefits to subscribers from network providers and
also called Exclusive Outpatient Benefits

d. A report sent to the employer with details of employee benefits paid for the month or
called Employer Out-of-Pocket Benefits

Question 77

Incorrect

Mark 0 out of 1

An amount that is waived by the provider and he occurs a loss. It is termed as ______

Select one:
a. Discount

b. Considered amount

c. Allowed amount

d. Write off

e. Contractual Adjustment 

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7/19/23, 4:23 PM Toll Gate – 01 Assessment (Effective April ‘21)

Question 78

Correct

Mark 1 out of 1

The role of a clearing house is

Select one:
a. Processing the claim for payment

b. Denying the invalid claim

c. Checking the status of claim

d. Sorting or rejecting claims with invalid format 

Question 79

Incorrect

Mark 0 out of 1

HMOs, POSs and PPOs all are considered _____________ and manage costs, use and quality
of the health care system.

Select one:
a. MCM

b. CDT

c. MCO

d. CDM 

e. CMS

Question 80

Incorrect

Mark 0 out of 1

Tax ID number is used for tax purposes that is provided by the CMS

Select one:
a. True 

b. False

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