question

A major innovation that simplified insurance claims submission was

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the CMS-1500 universal claim form

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Which of the following organizations is responsible for creating the revised CMS-1500 (08-05)?

answer

NUCC/NUBC

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The front side of the paper CMS-1500 form is printed in

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33 individual blocks OCR scannable red ink both a and b

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On the CMS-1500 form, patient information entered in

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the top of the form

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The most common format used for computer test files and on the Internet is

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ASCII

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OCR works best with original copies using

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monospaced fonts

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Specific guidelines for OCR scannable claims include all the following except

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inserting correct punctuation

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Medicare claims must be submitted electronically, unless the HHS secretary grants a/an

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waiver

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One category that may be exempt from mandatory electronic claim submission is a/an

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small provider

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Documents needed to complete a paper CMS-1500 include all of the following except a

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patient's driver's license

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The multipurpose billing document used by many providers is called a/an

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all of the above superbill encounter form patient service slip

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The document on which patients' charges and payments are recorded is the

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ledger card

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An example of a correctly reported birth date in block 3 of the CMS-1500 is

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09 14 2008

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When the health insurance professional extracts certain information from a patient's health record to complete the CMS-1500 it's called

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abstracting

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A business entity that receives claims from providers, consolidates them, and sends them on to various third-party payers is called a

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claims clearinghouse

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Submitting insurance claims directly to a third-party payer is called

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direct date entry

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A claim that has no errors or omissions and can be processed without delays is called a __ claim.

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clean

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The main reason for revising the CMS-1500 form is for

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HIPPA-mandated NPIs

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The nine-digit federal tax identification number is commonly referred to as the

answer

EIN

question

The bottom half of the CMS-1500 form is used for ___ information

answer

physician/supplier

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The deadline (for most healthcare facilities) to begin using the CMS-1500 (08-05) paper form is/was

answer

May 23, 2007

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One of the recent technological advances that makes verification of patient insurance eligibility easier and faster is the

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interactive voice response (IVR)

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CMS has published its rules for attachments for electronic claims in the

answer

Federal Register

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The primary objective of a health insurance professional is to

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submit "clean" claims

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"A provider of services with fewer than 24 full-time employees or a physician, practitioner, facility, or supplier (other than a provider of services) with few than 10 full-time equivalent employees" is the acceptable definition for

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"small provider" criteria

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The AMA developed the first CMS-1500 claim form for military use

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False

question

HIPPA includes administrative simplification provisions that include standards for electronic claims submission.

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True

question

Provider who are not computerized can use the paper version of the CMS-1500.

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True

question

Names, addresses, Social Security Numbers, and employment information are referred to as demographics.

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True

question

Every insurance company has a unique identification card that it issues to its subscribers.

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True

question

The federal government mandates the use of "universal" encounter form for all providers.

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False

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A paper claim cannot be submitted to a third-party carrier unless the patient assigns benefits.

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False

question

The revised CMS-1500 claim for (08-05) requires the use of national provider identifiers for providers of service.

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True

question

If a claim is computer generated, there is no need for proofreading.

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False

question

One way to track submitted claims is through the use of an insurance claims tracking form of "log".

answer

True

question

All electronic claims must be routed through a claims clearinghouse.

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False

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Special software may be required to send claims directly to a third party

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True

question

Direct claim submission is considered the best method if most claims are being sent to a single carrier.

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True

question

One of the important inclusions in the revised CMS-1500 (08-05 form) is the NPI number.

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True

question

Failure to confirm a patient's insurance coverage can create a delay in payment or result in no payment at all.

answer

True

question

Guidelines for claim attachments are the same if the medical facility uses electronic claim submission

answer

True

question

If Block 17 on the CMS-1500 (08-05) is blank, Block 17b should also be left blank.

answer

True

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If there are entries in both Blocks 17 and 17b, Blocks 24i and 24j must be left blank.

answer

False

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Signature on File of SOF is an acceptable entry in Block 31

answer

True

question

A claims clearinghouse is a company that receives multiple claims from healthcare providers, edits each for validity and accuracy, and routes the edited claims on to the proper carrier for payment.

answer

True

question

The two main sections of the CMS-1500 are __ and __

answer

patient, supplier

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The format required for completing paper claims so that it can be "scanned' is

answer

OCR, optical character recognition

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The patient/insured section of the CMS-1500 includes blocks __ to __

answer

1 to 13

question

The ___ submission may grant a waiver from the mandatory electronic claims submission rule.

answer

HHS

CMS-1500 Form: Creation and Features

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