question

HIAA & AMA

answer

Who developed the Standard Form?

question

Universal Claim form - CMS-1500 (08-05)

answer

State the name of the insurance form approved by the American Medical Association.

question

Yes. It is required.

answer

Does Medicare accept the CMS-1500 (08-05) claim form?

question

When two insurance policies are involved. A primary and a secondary.

answer

What is dual coverage?

question

Primary payer.

answer

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

question

Release of Information Form signed by the patient.

answer

What important document must you have before an insurance company can photocopy a patient's chart?

question

To the Insurance Company

answer

If the patient brings in a private insurance form that is not group insurance, where do you send the form after completion?

question

Resubmit.

answer

An insurance claim is returned for the reason "diagnosis incomplete." State one or more solutions to this problem on how you would try to obtain reimbursement.

question

Eight. MMDDYYYY

answer

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

question

Medigap-Medicaid

answer

Define this abbreviation: MG/MCD

question

life or health insurance application

answer

A three-part information form that is completed and signed by an insurance agent and an individual to obtain insurance coverage, and requires a medical examination by a physician is known as:

question

CMS-1500 (08-05) claim form

answer

The insurance claim form required when submitting Medicare claims is:

question

eight

answer

The maximum number of diagnostic codes in the ANSI 837P claim format for transmitting for transmitting electronic health insurance claim is:

question

female

answer

If a patient's gender is not indicated in the CMS-1500 (08-05) claim form, the gender block defaults to:

question

IC

answer

If a provider or medical services does not have a NPI number, the characters or digits that must be entered in Block 24I is/are:

question

A photocopy of claim form may be optically scanned.

answer

False

question

Handwriting is permitted on optically scanned paper claims.

answer

False

question

A CMS-assigned National Provider Identifier (NPI) number consists of 10 characters.

answer

True

question

When listing a diagnostic code on an insurance claim, insert the deceimal point.

answer

False

question

A diagnosis reference pointer should be entered in Block 24E and not ICD-9-CM diagnostic code.

answer

True

question

an insurance form that is complete without errors.

answer

Clean Claim

question

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

answer

Deleted Claim

question

a claim submitted with errors or one that requires manual processing to resolve problems or is rejected for payment

answer

Dirty Claim

question

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

answer

Durable Medical Equipment (DME) Number

question

a health care claim that is transmitted electronically; also known as an electronic media claim (EMC)

answer

Electronic Claim

question

The number used by the Internal Revenue Service that identifies a business or individual functioning as a business entity for income tax reporting.

answer

Employer Identification Number (EIN)

question

a facility's provider number used to bill for services to show WHERE procedure was done

answer

Facility Provider Number

question

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

answer

Group National Provider Identifier (Group NPI)

question

CMS 1500; universal insurance claim

answer

Health Insurance Claim Form (CMS-1500 [08-05])

question

is any Medicare claim missing required information

answer

Incomplete Claim

question

A device that can read typed characters at very high speed and convert them to igitized files that can be saved on disk. (also known as OCR, Optical character recognition)

answer

Intelligent Character Recognition (ICR)

question

any medicare claim that contains complete, necessary information but is illogical or incorrect

answer

Invalid Claim

question

A lifetime number consisting of 10 digits that Medicare will use to replace the Provider Identification Number(PIN) and the Unique Physician Identification number (UPIN).

answer

National Provider Identifier (NPI)

question

A device that can read typed characters at very high speed and convert them to igitized files that can be saved on disk. (also known as ICR, intelligent character recognition)

answer

Optical Character Recognition (OCR)

question

Medicare claims not considered "clean claims" wich require investigation or development on prepayment basis.

answer

"Other" Claims

question

submitted using CMS-1500 and mailing it to the insurance company to be optically scanned

answer

Paper Claims

question

is a claim that has been held in suspense while it is being reviewed or waiting for additional information

answer

Pending Claims

question

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

answer

Physically Clean Claim

question

an insurance claim submitted to an insurance carrier that is discarded by the system because of a technical error or because it does not follow medicare instructions

answer

Rejected Claim

question

An individual's tax identification number issued by the federal government.

answer

Social Security Number (SSN)

question

A number issued to a physician who has passed the state medical examinhation indicating his or her right to practice medicine in the state where issued.

answer

State License Number

question

Acquired Immune Deficiency Syndrome

answer

AIDS

question

American Medical Association

answer

AMA

question

Clinical Laboratory Improvement Amendments

answer

CLIA

question

Centers for Medicare and Medicaid Services Health Insurance Claim Form

answer

CMS-1500

question

coordination of benefits

answer

COB

question

durable medical equipment

answer

DME

question

does not apply

answer

DNA

question

electrocardiogram

answer

ECG

question

Employer Identification Number

answer

EIN

question

emergency

answer

EMG

question

Explanation of Benefit

answer

EOB

question

early, periodic, screening, diagnosis, and treatment

answer

EPSDT

question

Food and Drug Administration

answer

FDA

question

home health agency or hospice health agency

answer

HHA

question

?

answer

HICN

question

Health Insurance Portability and Accountability Act

answer

HIPAA

question

Human Immunodeficiency Virus

answer

HIV

question

Health Maintenance Organization

answer

HMO

question

intelligent character recognition

answer

ICR

question

investigational device exemption

answer

IDE

question

last mentrual period

answer

LMP

question

Medicaid

answer

MCD

question

Medigap

answer

MG

question

Medicare Secondary Payer

answer

MSP

question

not applicable

answer

NA, N/A

question

not otherwise classified

answer

NOC

question

National Provider Identification Number

answer

NPI

question

non physician practitioner

answer

NPP

question

other carrier name and address key

answer

OCNA key

question

optical character recognition

answer

OCR

question

payer identification

answer

PAYERID

question

peer review organization or professional review organization

answer

PRO

question

signature on file

answer

SOF

question

Social Security Number

answer

SSN

question

Tricare Management Activity

answer

TMA

question

Acquired Immune Deficiency Syndrome

answer

AIDS

question

American Medical Association

answer

AMA

question

Clinical Laboratory Improvement Amendments

answer

CLIA

question

Centers for Medicare and Medicaid Services Health Insurance Claim Form

answer

CMS-1500

question

coordination of benefits

answer

COB

question

durable medical equipment

answer

DME

question

does not apply

answer

DNA

question

electrocardiogram

answer

ECG

question

Employer Identification Number

answer

EIN

question

emergency

answer

EMG

question

Explanation of Benefit

answer

EOB

question

early, periodic, screening, diagnosis, and treatment

answer

EPSDT

question

Food and Drug Administration

answer

FDA

question

home health agency or hospice health agency

answer

HHA

question

?

answer

HICN

question

Health Insurance Portability and Accountability Act

answer

HIPAA

question

Human Immunodeficiency Virus

answer

HIV

question

Health Maintenance Organization

answer

HMO

question

intelligent character recognition

answer

ICR

question

investigational device exemption

answer

IDE

question

last mentrual period

answer

LMP

question

Medicaid

answer

MCD

question

Medigap

answer

MG

question

Medicare Secondary Payer

answer

MSP

question

not applicable

answer

NA, N/A

question

not otherwise classified

answer

NOC

question

National Provider Identification Number

answer

NPI

question

non physician practitioner

answer

NPP

question

other carrier name and address key

answer

OCNA key

question

optical character recognition

answer

OCR

question

payer identification

answer

PAYERID

question

peer review organization or professional review organization

answer

PRO

question

signature on file

answer

SOF

question

Social Security Number

answer

SSN

question

Tricare Management Activity

answer

TMA

Ch 7 The Paper Claim

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