question

ASCA

answer

Administrative Simplification Compliance Act

question

CMS-1500

answer

Centers for Medicare and Medicaid Services Health Insurance Claim Form.

question

DME

answer

Durable Medical Equipment

question

DNA

answer

Does Not Apply

question

EIN

answer

Employer Identification Number

question

EMG

answer

Emergency

question

EPSDT

answer

Early and Periodic Screening Diagnosis and Treatment

question

ICR

answer

Intelligent Character Recognition or Image Copy Recognition.

question

LMP

answer

Last Menstrual Period

question

MSP

answer

Medicare Secondary Paper

question

NA, N/A

answer

Not Applicable

question

NPI

answer

National Provider Identifier

question

NUCC

answer

National Uniform Claim Commitee

question

OCR

answer

Office of Civil Rifgts

question

SOF

answer

Signature on file

question

SSN

answer

Social Security Number

question

ALJ

answer

Administrative Law Judge

question

CMS

answer

Centers for Medicare and Medicaid Services

question

DAB

answer

Departmental Appeal Board

question

EOB

answer

Explanation of Benefits

question

ERISA

answer

Employee Retirement Income Security Act

question

FTC

answer

Federal Trade Commission

question

HIPAA

answer

Health Insurance Portability and Accountability Act

question

HMO

answer

Health Maintenance Organization

question

HO

answer

Hearing Officer

question

RA

answer

Remittance Advice

question

NP

answer

new patient

question

UA

answer

urinalysis

question

Dx

answer

diagnosis

question

ptr

answer

patient to return

question

Cysto

answer

cystoscopy

question

pt

answer

Patient

question

cont

answer

continue

question

adm

answer

admit

question

hosp

answer

hospital

question

C

answer

cervical

question

hx

answer

History

question

exam

answer

examination

question

LC

answer

low complexity

question

MDM

answer

Medical Decision Making

question

HV

answer

Hospital visit

question

PF

answer

problem focused

question

SF

answer

straight foward

question

RTO

answer

return to office

question

postop

answer

postoperative

question

OV

answer

office visit

question

lb

answer

pound

question

adv

answer

advise

question

retn

answer

return

question

est

answer

established

question

CBC

answer

complete blood count

question

CC

answer

chief complaint

question

diff

answer

differential

question

PSA

answer

prostate specific antigen

question

bx

answer

biopsy

question

STAT

answer

immediately

question

PTR

answer

patient to return

question

CA

answer

cancer,carcinoma

question

surg

answer

surgery

question

TURP

answer

transurethral resection of prostate

question

hv

answer

Hospital visit

question

pf

answer

problem focused

question

Disch

answer

discharge

question

Er

answer

emergency room

question

BP

answer

blood pressure

question

GI

answer

Gastrointestinal

question

EGD

answer

esophagogastroduodenoscopy

question

ofc

answer

office

question

wk

answer

week

question

clean claim

answer

completed insurance claim form submitted with the program time limit that contains all necessary info. w/o deficiencies so that it can be processed and paid promptly

question

deleted claim

answer

insurance claim the claim has not been processed or cannot be processed for various reasons.

question

durable medical equipment number

answer

a group /individual provider number used when submitting bills for specific medical supplies, devices, and equipment to the Medicare fiscal intermediary for reimbursement

question

electronic claim

answer

alternative to paper claim, submitted to payer directly by physician or clearinghouse. Are usually paid faster. Most electronic claims software have self-editing features that detect and report entries that may cause to be rejected, such as invalid codes or incomplete claims

question

employer identification number

answer

9 digit number for tax accounting provided by the IRS(internal revenue service)

question

facility provider number

answer

A facility's (hospital, laboratory radiology office, nursing facility) provider number to be used by the facility to bill for services, or by the performing physician to report services done at that location

question

group national provider identifier (group npi)

answer

A number assigned to a group of physicians submitting insurannce cliams under the group name and reporting income under one name.

question

health insurance claim form (cms-1500 [02-12])

answer

Documentation submitted to an insurance plan requesting reimbursement for health care services provided.

question

incomplete claim

answer

claim missing required information

question

intelligent character recognition

answer

The electronic scanning of printed blocks as images and the use of special software to recognize these images or characters as ASCH text for uploading into a computer database.

question

invalid claim

answer

contains complete necessary information but is incorrect or illogical in some way

question

national provider identifier

answer

number assigned to any health care provider that is used for the purpose of standardizing health data transmissions

question

optical character recognition

answer

The ability of software to convert digitized documents into american standard code for information interchange text that can be searched read and edited by word processing and other kinds of software

question

paper claim

answer

this type of claim you mail to the insurance company

question

pending claim

answer

Claim that is held in suspense for review. It may be cleared for payment or denied

question

physically clean claim

answer

Insurance claims with no staples or highlighted areas. The bar code areas has not been deformed.

question

rejected claim

answer

A claim that is discarded by the insurance company because of a technical error

question

social security number

answer

A 9 digit number (e.g. 000-00-0000) that is used by American citizens to identify them.

question

state license number

answer

A number a physician must obtain to practice in a state

question

What legislation required all claims sent to the Medicare program be submitted electronically, effective October 16, 2003?

answer

ASCA Administrative Simplification Compliance Act

question

State the name of the health insurance claim form that was required for use effective April 1, 2014.

answer

CMS-1500 (02-12)

question

Does Medicare accept the CMS-1500 (02-12) claim form?

answer

Yes

question

What is a pended claim?

answer

A claim that is held in suspense for review or other reasons by the third-party payer

question

How many days will it take to process a Medicare claim that is submitted electronically?

answer

14 days

question

IF a claim is submitted on behalf of the patient, and coverage of the services is denied, what is the most effective way to present the situation to the patient?

answer

Send/show them the official rejection statement from the insurance company

question

What is dual coverage?

answer

When a patient had more than one insurance company's coverage

question

The insurance company with the first responsibility for payment of a bill for medical services is known as the..

answer

Primary carrier

question

The CMS-1500 (02-12) claim form allows for reporting of a maximum of ______ diagnosis codes per claim form.

answer

12

question

What Internet resource can be used to find physician provider numbers?

answer

NPI registry

question

For electronic submission of claims, what allows the physician's name to be printed in the signature block where it would normally be signed?

answer

SOF- signature on file

question

When preparing a claim that is to be optically scanned, birth dates are keyed in with how many digits?

answer

MMDDYYYY 6 or 8

question

Claim missing required information

answer

incomplete claim

question

Phrase used when a claim is held back from payment

answer

pending claim

question

Claim that is submitted and then optically scanned by the insurance carrier and converted to electronic form

answer

paper claim

question

Claim that needs manual processing because of errors or to solve a problem

answer

dirty claim

question

Claim that needs clarification and answers to some questions

answer

rejected claim

question

Claim that is canceled or voided if incorrect claim form is used or itemized charges are not provided

answer

incomplete claim

question

Claim that is submitted via telephone line or computer modem

answer

electronic claim

question

Claim that is submitted within the time limit and correctly completed

answer

clean claim

question

Medicare claim that contains information that is complete and necessary but is illogical or incorrect

answer

invalid claim

question

a number issued by the federal government to each individual for personal use

answer

Social Security Number

question

a Medicare lifetime provider number

answer

National Provider Identifier

question

a number listed on a claim when submitting insurance claims to insurance companies under a group name

answer

Group national provider number

question

a number that a physician must obtain to practice in a state

answer

State license number

question

a number used when billing for supplies and equipment

answer

durable medical equipment number

question

a number issued to a hospital

answer

facility provider number

question

an individual physician's federal tax identification number issued by the Internal Revenue Service

answer

employer identification number

question

The basic claim form currently used by healthcare professionals and suppliers to bill insurance carriers for services provided to patients is the...

answer

CMS-1500 (02-12) claim form

question

What is the exception to the Administrative Simplification Compliance Act's (ASCA's) requirement for providers to send claims to Medicare electronically?

answer

providers with fewer than 10 full-time employees

question

Under ASCA, plans other than Medicare

answer

may allow submissions of claims on paper

question

the National Uniform Claim Committee (NUCC) is made up of

answer

AMA representatives CMS representatives providers

question

The first standardized insurance claim form developed in 1958 was known as the

answer

COMB-1

question

The most recently revised version of the 1500 Health Insurance Claim Form developed in 2012 accommodates

answer

the change in the names of the government agency from health care finance administration to center for medicare and medicaid services (CMS)

question

If a patient has dual coverage,

answer

insurance information for both the primary and the secondary carrier should be obtained

question

Health Insurance Portability and Accountability Act (HIPAA) laws require that the provider rendering the service be identified on the claim form by

answer

reporting of the correct provider number

question

The Omnibus Budget Reconciliation Act (OBRA) requires Medicare administrative contractors to

answer

pay interest on all clean claims not paid on time

question

A claim that is investigated on a post payment basis that is found to be \"not due\" will require

answer

refund of all the monies paid

question

If there is a balance remaining on a patient's account after the patient's primary insurance has paid, and the patient has secondary coverage, the billing specialist should

answer

send claim form to the secondary insurance for the remaining balance

question

The maximum number of diagnostic codes that can be submitted on the CMS-1500 (02-12) claim form is

answer

twelve

question

The National Provider Identifier (NPI) numbers are used to report

answer

referring physician's ordering physician's performing physician's

question

NPI numbers are assigned

answer

once in a lifetime, per health care provider

question

To correct a claim that has been denied because of an invalid procedure code, the billing specialist should

answer

confirm the code in the CPT manual to ensure it is valid for the date of service

question

To correct a claim that was denied because more than six lines were entered on the claim

answer

bill six claim lines on one claim and complete an additional paper claim for the additional claim lines

question

The insurance billing specialist does not need to know how to complete a paper claim because most claims are submitted electronically

answer

False

question

Physicians who experience downtimes of Internet services that are out of their control for more than 2 days may submit claims to Medicare on paper

answer

True

question

the goal of the NUCC is to provide a warehouse for providers to purchase CMS-1500 claim forms

answer

False

question

Effective June 1, 2013, providers were required to use only the CMS-1500 (02-12) claim form

answer

False

question

Use of the standardized CMS-1500 (02-12) claim form has simplified processing of paper claims

answer

True

question

Quantities of the CMS-1500 (02-12) claim form can be purchase through CMS or downloaded from the CMS website and used for submission

answer

False

question

Interest rates that apply to the Prompt Payment Interest Rate can be located on the Treasury's Financial Management Service page

answer

False

question

Medicare claims that require further investigation before being processed are referred to as \"other\" claims

answer

False

question

A diagnosis should never be submitted without supporting documentation in the medical record

answer

True

question

Claims fo dates of services in two different years may be submitted on the same claim form

answer

False

question

Services that are inclusive in the global surgical package that have no charge associated with them should not be submitted on the CMS-1500 claim form

answer

True

question

Proofreading claims before submission can prevent denials and delay of claim processing

answer

True

question

when submitting supplemental documentation for processing of a claim, the patient's name and date of service need only be on the form of a two-sided document

answer

False

question

handwriting is permitted on optically scanned paper claims

answer

False

question

use the abbreviation \"DNA\" when information is not applicable

answer

False

Chapter 7 The Paper Claim: CMS-1500 (02-12)

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