question

When a patient is seen by his surgeon for postoperative complications, any services provided are

answer

billed as an additional procedure

question

According to optical scanning guidelines, the punctuation that is acceptable when it is part of the patient's name is a (n)

answer

CMS-1500 paper claim

question

Birth dates are entered as_________ format on the CMS-1500 claim depending on block instructions.

answer

eight digits

question

The diagnosis code reported in item 1, Block 21, of the CMS-1500 claim is the

answer

single claim

question

Items 1-4 in Block 21 of the CMS-1500 claim link the lsted diagnosis codes to their appropriate procedure/service code reported in Block 24. This items are known as diagnosis ______numbes

answer

four

question

The legal business name of the practice is also called the

answer

billing entity

question

The unique identifier that CMS will assign to providers as part of HIPPA requirements is called the__________

answer

National Provider Identification (NPI)

question

The maximum number of CPT and / or HCPCS modifiers that can be reported in Block 24 of the CMS -1500 claim is ___

answer

4-6 0r 6

question

Block 25 of the CMS-1500 claim requires entry of either the provider's social security number or the _________

answer

EIN

question

Which character is entered in the boxes of Block 8 of the CMS-1500 claim to indicate patient status?

answer

X

question

When entering the diagnosis codes in Block 21 of the CMS-1500, which/what is entered instead of the decimal?

answer

codes

question

A patient whose birthday is January 5, 1965, would be entered on the CMS-1500 as______________

answer

01 05 1965

question

A total charge of $900 would be entered on the CMS-1500 as

answer

900 00

question

What is reported in Block 24E of the CMS-1500?

answer

diagnosis pointer numbers

question

When reporting anesthesia time in Block 24G, how must the time be entered?

answer

1

question

Provider services for inpatient medical cases are billed on what basis?

answer

Nonphysician Practitioner (NPP)

question

Which prohibits a payers from notifying a provider about payment or rejections on unassigned claims?

answer

Insurance File Set-Up

question

Medicare Conditions of Participation (Cop) require providers to maintain copies of government insurance claims and attachments submitted for what period of time?____

answer

5 years

question

When the patient signs Block 13 of the CMS-1500, allowing payment to go directly to the provider, this is known as ___

answer

SIGNATURE ON FILE

question

When an "X" is entered in one or more of the YES boxes in Block 10 of the CMS-1500 claim, this may indicate that

answer

Is Patient's Condition Related

question

When is it appropriate to file a patient's secondary insurance claim?

answer

Filed only after the remmittance generated

question

An example of a supplement insurance plan is ______

answer

Medigap

question

Which diagnosis is condered a chronic condition that would always affect patient care?

answer

Diabetes Mellitus

question

In Block 24G _____ units would be entered based on the following statement: Three-view sinus series.

answer

1

question

When the patient signs a special form that has been placed in the financial or medical record, it is acceptable to enter what prahse in Block 12 and/or Block 13 of the CMS -1500 claim?

answer

SIGNATURE ON FILE

question

The "birthday rule" applies when dependent children living at home are covered by ore than one health insurance policy. The primary policy is determined by the parent___

answer

subscribes to a different health insurance plan

question

The Patient is covered by two health insurance policies, his own employer's group health plan and his spouse's employer's group health plan. Which plan is primary for the Patient?

answer

Commercial Health Insurance

question

When a patient is covered by a government health program? ( e.g., Medicare ) and an employer group health plan, Which is considered primary

answer

Government Health Program

question

When a patient is listed as a dependent on her spouse's employer group health plan (EGHP) and is covered by an EGHP of her own, the spouse's plan is considered

answer

Primary

question

The patient's birth date is January 5, 1967. This is entered in Block 3 of the CMS-1500 claim as________

answer

01 05 1967

question

When the patient and policyholder are identical, Block 4 of the CMS-1500 claim will contain_______

answer

Insurance Name

question

For Patients between the ages of 19 and 23 who are named as dependents on a family policy, and who are full-tume students, enter an X in the appropriate box of ___________

answer

8

question

When an X appears in the YES box in Block 10Aa of the CMS-1500 claim, this indicates____

answer

Employement

question

Deductibles, copayments, and coinsurance expenses are usually covered by what type of plan?

answer

High Deductible Health Plan

question

When a patient is referred to a consultant, what is entered in Block 17 of the CMS-1500 claim?

answer

Name of Referring Provider

question

If laboratory procedures are performed in the provider's office, how is this indicated on the CMS-1500 claim?

answer

Check YES or No by placing an (X) in the center of the box to indicate whether the lab will enter the word NONE in item 11 of the CMS-1500 Form.

question

If the provider's employer tax identification number (EIN) is unavailable, what is acceptable to enter in Block 25 of the CMS-1500?

answer

Social Security Number (SSN)

question

Losses to a third party caused by the insured, bu an object owned by the insured, or on premises owned by the insured are covered by________insurance

answer

Liability

question

The Shaded area in each line of Block 24 is used to enter supplemental information to support reported services if instructed by thepayer to enter such information. Data entry Block 24 is limited to reporting ___services

answer

Dates of

question

Collision is a type of automobile insurance that pays for

answer

damaged to covered vehicle caused by collision with another objext by automobile accident, a deductible is required

question

In Block 2 of the CMS-1500, the patient's last name, first name, and middle initial are each separated by a _______

answer

Patient's Name

question

If the same payer providers both the primary and secondary coverage, submit________

answer

Commmercial Secondary Coverage

question

When filing commercial insurance claims, what information from a nonPAR provider is required in Block 33 of the CMS-1500?

answer

Billing provider information and PH number

question

In Which Block on the CMS-1500 is a prior authorization number for a procedures or services entered?

answer

24D

question

Enter an X in the YES box of Block 27 to indicate that the provider agrees to___

answer

Accept Assignment

question

Payment for medical treatment of an injury will be denied by the liability payer if______________________

answer

it is determined that there was no third party negligence

question

Which automobile insurance policy coverage can provide for expenses such as lost earnings, rehabilitation, and child care expenses, regardless of fault?

answer

Personal Injury Protection (PIP)

question

Disability insurance typically provides what type of compensation to the injured person?

answer

workers

question

The file claim with a liability payer, which form may serve as a substitute for an insurance claim?

answer

regular patient billing statement

question

What term decribes the contractual right of a third-party payer to recover healthcare expenses from a liable party?

answer

Healthcare Insurance and Group Healthcare Insurance

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