question

presently, most health care organizations send the majority of their claims on paper

answer

true

question

it is not important for the health insurance specialist to understand how to complete a paper claim

answer

false

question

the AMA was named in the administrative simplification of the HIPPA of 1996 as the authoritative voice regarding national standard content for submission of claims

answer

false

question

a photocopy of the CMS-1500 form is acceptable if the form processed by the insurance carrier through scanning equipment

answer

false

question

a paper claim is one that is submitted on paper, then optically scanned and converted to electronic form by insurance companies

answer

True

question

a physically clean claim is one that has all necessary info required reported on it.

answer

false

question

a dirty claim is one that had coffee spilled on it before sending it to an ins carrier

answer

false

question

most ins carriers accept the CMS-1500 claim from except TRICARE and the blue plans .

answer

False

question

if the patient will oblige, let the patient direct his/her own ins form when signed assignment of benefits form is retained in the patients health record.

answer

false

question

signature on file may be indicated on the CMS-1500 claim form when a signed assignment of benefits form is retained in the patients health record,

answer

true

question

if several services are being billed on the same ins claim form, you may \"ditto\" the dates on each line of service below the first line.

answer

false

question

list all services on the ins claim form, including \"no charge\" services.

answer

False

question

according to OCR guidelines , all info on the CMS-1500 claim form should be typed inn uppercase

answer

true

question

the CMS-1500 is known as the

answer

basic paper claim

question

ASCA required

answer

all claims sent to medicare be submitted electronically

question

the uniform claim form task force was replaced by

answer

national uniform claim commitee

question

in 2012 the CMS-1500 claim form was revised to version 02-12 to accommodate

answer

ICD-10 diagnosis codes

question

an ins claim from that contains no staples or highlighted areas and on which the bar code area has not been deformed is called a/an

answer

clean claim

question

an ins claim submitted with errors is refered to as a

answer

dirty claim

question

when a patients has dual coverage the ins considered the primary ins is

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generally the policy held by the patient

question

when completeing a claim form, if any question is unanswerable,

answer

leave the space blank

question

the appropriate method for entering the date of servicee (january 4, 2XXX) on as claim form is

answer

01042xxx

question

office visits may be grouped on the ins claim form if each visit

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is consecutive, uses the same procedure code, and results in the same fee.

question

the number issue to physicians as a lifetime 10-digit number that replaces all other numbers assigned by various health plans is the

answer

NPI

question

medicare providers who charge paitents a fee for supplies and equiment such as crutches, urinary catheders, and walkers must send the claim to

answer

a specific DME fiscal intermediary.

question

when medication are considred to be expiramental, the claim should be sent to the

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ins carrier w/ a copy of the invoice from the supply house

question

OCR is an acronym for

answer

optical character recognition

question

to confirm to CMS-1500 OCR guidelines

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do not fold ins claims when mailing, do not use symbols w/ data on ins claim forms, and do not strike out over errors when making a correction on an ins claim form

question

the CMS-1500 claim from is divided into which of the following major sections

answer

patient and physician info

question

the objective of the administration simplification compliance act was to improve the administration of the medicare program by increased inefficiencies resulting from

answer

electronic claims submissions

question

ASCA provides exceptions to the medicare electronic claims submission requirements to _____providers

answer

small

question

health ins specialists should be familiar with the paper claim, as there may be occasions where the practice experiences technical________ and is unable to to submit claims electronically.

answer

downtime

question

the NUCC is charged w/ the task of __________ national instructions for completion of the CMS-1500 claim form.

answer

standardizing

question

the paper claim from was revised in 1990 and printed in red ink to allow --------------- of claims

answer

optical scanning

question

the paper claim form was revised in 2005 to allow reporting of ---- for physicians

answer

NPI

question

effective ______ the revised paper claim form (02-12) will be required for use by all providers.

answer

10/1/13

question

the CMS-1500 paper claim can be purchased through a medical office supply company or through the

answer

AMA

question

A CLAIM THAT IS SUBMITTED TO THE INS CARRIER VIA INTRNET CONNECTION IS REFERRED TO AS

answer

ELECTRONIC

question

a clean claim has no ------- and passes all electronic edits

answer

deficiencies

question

abstraction of technical info from patient records may be necessary to support medical

answer

necessity

question

when submitting a letter to an ins company to explain unusual circumstances that should be considered when processing a claim, it should be sent to te attention of the

answer

Claims supervisor

question

when completing a claim form for a patient who has group ins coverage, it is important to complete all info regarding the patients .

answer

employer

question

the diagnosis field of the CMS-1500 claim form is referred to as block

answer

21

question

to practice medicine within a state, a physicain must obtain a physicians state

answer

license

question

when a non-physician practitioner sees a patient in an office, while another physician in the practice provides direct supervision, the claim can be billed to medicare using the physicians NPI, referred to as _________ services

answer

incident to requirement

question

all paper claims generated should be -------- for misspelling of patients

answer

proofread

question

copies of submitted claim forms should be maintained in a ticker file and followed up on every ---- days

answer

30

question

an ins claim that is submitted on paper, including optical scans

answer

paper claims

question

a medicare claim that is missing required info

answer

incomplete claim

question

an ins claim held in suspesne due to review or other reasons

answer

pending claim

question

an ins claim that requires investigation and needs further clarification

answer

rejected claim

question

an ins claim that is submitted within the program or policy time limit and correctly completed

answer

clean claim

question

an ins claim that is submitted via a dial up modem or direct data entry

answer

electronic claim

question

an ins claim that is submitted w/ errors

answer

dirty claim

question

a medicare claim that contains complete, necessary, info but is illogical or incorrect

answer

invalid claim

question

missing place of service code

answer

verify that the place of service is correct for the submitted procedure codes and fill in correct service code

question

the ins claim was submitted to the secondary instead of the primary

answer

obtain data from paitent during the first office visit on which company is the primary insurer

question

patients name and insured's name are entered as the same when patient is dependent

answer

check for Sr., Jr., correct birth date, and verify the insured.

question

the paitents ins number in incorrect

answer

proofread numbers carefully from source documents

question

incorrect modifier

answer

verify and submit valid modifiers w/ the correct procedure codes for which they are valid

question

operative report is missing from the ins claim

answer

submit all attachments with paitents name and ins identification number

question

procedure code is invalid

answer

refer to a current procedure code books and verify the coding system used by the ins company

question

diagnostic code is missing

answer

refer to an updated diagnostic codebook and review the patients record.

question

total amounts do not equal itemized amounts charged

answer

total all charges on each claim, recheck the math, and verify amounts with patient account.

question

duplicate dates of service listed

answer

verify with the patients medical record that all dates of services are listed and accurate

Paper Claims and HIPAA Compliance

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