Paper Claims and HIPAA Compliance

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presently, most health care organizations send the majority of their claims on paper
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true
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it is not important for the health insurance specialist to understand how to complete a paper claim
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false
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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
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false
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a photocopy of the CMS-1500 form is acceptable if the form processed by the insurance carrier through scanning equipment
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false
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a paper claim is one that is submitted on paper, then optically scanned and converted to electronic form by insurance companies
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True
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a physically clean claim is one that has all necessary info required reported on it.
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false
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a dirty claim is one that had coffee spilled on it before sending it to an ins carrier
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false
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most ins carriers accept the CMS-1500 claim from except TRICARE and the blue plans .
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False
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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.
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false
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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,
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true
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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.
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false
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list all services on the ins claim form, including \"no charge\" services.
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False
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according to OCR guidelines , all info on the CMS-1500 claim form should be typed inn uppercase
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true
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the CMS-1500 is known as the
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basic paper claim
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ASCA required
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all claims sent to medicare be submitted electronically
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the uniform claim form task force was replaced by
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national uniform claim commitee
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in 2012 the CMS-1500 claim form was revised to version 02-12 to accommodate
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ICD-10 diagnosis codes
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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
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clean claim
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an ins claim submitted with errors is refered to as a
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dirty claim
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when a patients has dual coverage the ins considered the primary ins is
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generally the policy held by the patient
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when completeing a claim form, if any question is unanswerable,
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leave the space blank
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the appropriate method for entering the date of servicee (january 4, 2XXX) on as claim form is
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01042xxx
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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.
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the number issue to physicians as a lifetime 10-digit number that replaces all other numbers assigned by various health plans is the
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NPI
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medicare providers who charge paitents a fee for supplies and equiment such as crutches, urinary catheders, and walkers must send the claim to
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a specific DME fiscal intermediary.
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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
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OCR is an acronym for
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optical character recognition
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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
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the CMS-1500 claim from is divided into which of the following major sections
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patient and physician info
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the objective of the administration simplification compliance act was to improve the administration of the medicare program by increased inefficiencies resulting from
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electronic claims submissions
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ASCA provides exceptions to the medicare electronic claims submission requirements to _____providers
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small
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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.
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downtime
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the NUCC is charged w/ the task of __________ national instructions for completion of the CMS-1500 claim form.
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standardizing
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the paper claim from was revised in 1990 and printed in red ink to allow --------------- of claims
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optical scanning
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the paper claim form was revised in 2005 to allow reporting of ---- for physicians
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NPI
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effective ______ the revised paper claim form (02-12) will be required for use by all providers.
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10/1/13
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the CMS-1500 paper claim can be purchased through a medical office supply company or through the
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AMA
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A CLAIM THAT IS SUBMITTED TO THE INS CARRIER VIA INTRNET CONNECTION IS REFERRED TO AS
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ELECTRONIC
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a clean claim has no ------- and passes all electronic edits
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deficiencies
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abstraction of technical info from patient records may be necessary to support medical
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necessity
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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
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Claims supervisor
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when completing a claim form for a patient who has group ins coverage, it is important to complete all info regarding the patients .
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employer
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the diagnosis field of the CMS-1500 claim form is referred to as block
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21
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to practice medicine within a state, a physicain must obtain a physicians state
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license
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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
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incident to requirement
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all paper claims generated should be -------- for misspelling of patients
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proofread
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copies of submitted claim forms should be maintained in a ticker file and followed up on every ---- days
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30
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an ins claim that is submitted on paper, including optical scans
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paper claims
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a medicare claim that is missing required info
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incomplete claim
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an ins claim held in suspesne due to review or other reasons
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pending claim
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an ins claim that requires investigation and needs further clarification
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rejected claim
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an ins claim that is submitted within the program or policy time limit and correctly completed
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clean claim
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an ins claim that is submitted via a dial up modem or direct data entry
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electronic claim
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an ins claim that is submitted w/ errors
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dirty claim
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a medicare claim that contains complete, necessary, info but is illogical or incorrect
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invalid claim
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missing place of service code
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verify that the place of service is correct for the submitted procedure codes and fill in correct service code
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the ins claim was submitted to the secondary instead of the primary
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obtain data from paitent during the first office visit on which company is the primary insurer
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patients name and insured's name are entered as the same when patient is dependent
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check for Sr., Jr., correct birth date, and verify the insured.
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the paitents ins number in incorrect
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proofread numbers carefully from source documents
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incorrect modifier
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verify and submit valid modifiers w/ the correct procedure codes for which they are valid
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operative report is missing from the ins claim
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submit all attachments with paitents name and ins identification number
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procedure code is invalid
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refer to a current procedure code books and verify the coding system used by the ins company
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diagnostic code is missing
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refer to an updated diagnostic codebook and review the patients record.
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total amounts do not equal itemized amounts charged
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total all charges on each claim, recheck the math, and verify amounts with patient account.
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duplicate dates of service listed
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verify with the patients medical record that all dates of services are listed and accurate
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