question

Congress- the

answer

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

question

CMS-1500 (02-12)

answer

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

question

Yes

answer

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

question

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

answer

What is a pended claim?

question

14 days

answer

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

question

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

answer

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?

question

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

answer

What is dual coverage?

question

Primary carrier

answer

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

question

12

answer

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

question

The State licensing board website

answer

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

question

The participating contract with the third-party payer that the physician has physically signed

answer

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

question

8- MMDDYYYY

answer

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

question

1. h- incomplete claim 2. f- pending claim 3. b- paper claim 4. d- dirty claim 5. g- rejected claim 6. i- incomplete claim 7. e- electronic claim 8. a- clean claim 9. c- invalid claim

answer

1.Claim missing required information 2. Phrase used when a claim is held back from payment 3. Claim that is submitted and then optically scanned by the insurance carrier and converted to electronic form 4. Claim that needs manual processing because of errors or to solve a problem 5. Claim that needs clarification and answers to some questions 6. Claim that is canceled or voided if incorrect claim form is used or itemized charges are not provided 7. Claim that is submitted via telephone line or computer modem 8. Claim that is submitted within the time limit and correctly completed 9. Medicare claim that contains information that is complete and necessary but is illogical or incorrect

question

1. c- Social Security Number 2. e- National Provider Identifier 3. d- Group national provider number 4. a- State license number 5. f- durable medical equipment number 6. g- facility provider number 7. b- employer identification number

answer

1. a number issued by the federal ggovernment to each individual for personal use 2. a Medicare lifetime provider number 3. a number listed on a claim when submitting insurance claims to insurance companies under a group name 4. a number that a physician must obtain to practice in a state 5. a number used when billing for supplies and equipment 6. a number issued to a hospital 7. an individual physician's federal tax identification number issued by the Internal Revenue Service

question

b. CMS-1500 (02-12) claim form

answer

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

question

c. providers with fewer than 10 full-time employees

answer

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

question

a. may allow submissions of claims on paper

answer

Under ASCA, plans other than Medicare

question

d. all of the above

answer

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

question

d. COMB-1

answer

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

question

c. changes in the Electronic Claims Submission Version 5010 837P

answer

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

question

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

answer

If a patient has dual coverage,

question

a. reporting of the correct provider number

answer

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

question

d. pay interest on all clean claims not paid on time

answer

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

question

c. refund of all the monies paid

answer

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

question

c. send a claim form to the secondary insurance with a copy of the EOB from the primary carrier

answer

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

question

d. twelve

answer

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

question

d. all of the above

answer

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

question

a. once in a lifetime, per health care provider

answer

NPI numbers are assigned

question

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

answer

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

question

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

answer

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

question

False

answer

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

question

True

answer

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

question

False

answer

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

question

False

answer

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

question

True

answer

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

question

False

answer

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

question

True

answer

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

question

True

answer

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

question

True

answer

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

question

False

answer

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

question

True

answer

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

question

True

answer

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

question

False

answer

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

question

False

answer

handwriting is permitted on optically scanned paper claims

question

False

answer

use the abbreviation "DNA" when information is not applicable

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

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