MRT 119 CHAPTER 7 (WORKBOOK & BOOK)
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WHAT LEGISLATION REQUIRED ALL CLAIMS SENT TO THE MEDICARE PROGRAM TO BE SUBMITTED ELECTRONICALLY, EFFECTIVE OCTOBER 16, 2003?
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ASCA (ADMINISTRATIVE SIMPLIFICATION COMPLIANCE ACT)
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STATE THE NAME OF THE HEALTH INSURANCE CLAIM FORM THAT WAS REQUIRED FOR USE EFFECTIVE OCTOBER 1, 2013
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CMS-1500 (02-12)
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HOW MANY DAYS WILL IT TAKE TO PROCESS A MEDICARE CLAIM THAT IS SUBMITTED ELECTRONICALLY?
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14 DAYS
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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?
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OFFICIAL REJECTION FROM INSURANCE COMPANY
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WHAT IS DUAL COVERAGE?
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TWO INSURANCES INVOLVED. ONE IS PRIMARY, ONE IS SECONDARY.
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THE CMS-1500 (02-12) CLAIM FORM ALLOWS FOR REPORTING OF A MAXIMUM OF __ DIAGNOSIS CODES PER CLAIM FORM
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12
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WHAT INTERNET RESOURCE CAN BE USED TO FIND PHYSICIAN PROVIDER NUMBERS?
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NPI REGISTRY
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CLEAN CLAIM
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CLAIM THAT IS SUBMITTED WITHIN THE TIME LIMIT AND CORRECTLY COMPLETED
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INCOMPLETE CLAIM
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CLAIM MISSING REQUIRED INFORMATION
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REJECTED CLAIM
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PHRASE USED WHEN A CLAIM IS HELD BACK FROM PAYMENT
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PAPER CLAIM
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CLAIM THAT IS SUBMITTED AND THEN OPTICALLY SCANNED BY THE INSURANCE CARRIER AND CONVERTED TO ELECTRIC FORM
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DIRTY CLAIM
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CLAIM THAT NEEDS MANUAL PROCESSING BECAUSE OF ERRORS OR TO SOLVE A PROBLEM
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PENDING CLAIM
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CLAIM THAT NEEDS CLARIFICATION AND ANSWERS TO SOME QUESTIONS
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DELETED CLAIM
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CLAIM THAT IS CANCELED OR VOIDED IF INCORRECT CLAIM FORM IS USED OR ITEMIZED CHARGES ARE NOT PROVIDED.
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ELECTRONIC CLAIM
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CLAIM THAT IS SUBMITTED VIA TELEPHONE LINE OR COMPUTER MODEM
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INVALID CLAIM
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MEDICARE CLAIM THAT CONTAINS INFORMATION THAT IS COMPLETE AND NECESSARY BUT IS ILLOGICAL OR INCORRECT
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THE BASIC PAPER CLAIM FORM CURRENTLY USED BY HEALTH CARE PROFESSIONALS AND SUPPLIERS TO BILL INSURANCE CARRIERS FOR SERVICES PROVIDED TO PATIENTS IS THE?
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CMS 1500-0212
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WHAT IS THE EXCEPTION TO ASCA'S REQUIREMENT FOR PROVIDERS TO SEND CLAIMS TO MEDICARE ELECTRONICALLY?
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PROVIDERS WITH FEWER THAN 10 FULL TIME EMPLOYEES
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STATE LICENSE NUMBER
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A NUMBER THAT A PHYSICIAN MUST OBTAIN TO PRACTICE IN A STATE
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EMPLOYER IDENTIFICATION NUMBER
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AN INDIVIDUAL PHYSICIAN'S FEDERAL TAX IDENTIFICATION NUMBER ISSUED BY A THE IRS
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SOCIAL SECURITY NUMBER
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A NUMBER ISSUED BY THE FEDERAL GOVERNMENT TO EACH INDIVIDUAL FOR PERSONAL USE
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GROUP NATIONAL PROVIDER NUMBER
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A NUMBER LISTED ON A CLAIM WHEN SUBMITTING INSURANCE CLAIMS TO INSURANCE COMPANIES UNDER A GROUP NAME
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NATIONAL PROVIDER IDENTIFIER
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A MEDICARE LIFETIME PROVIDER NUMBER
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DURABLE MEDICAL EQUIPMENT NUMBER
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A NUMBER USED WHEN BILLING FOR SUPPLIES AND EQUIPMENT
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FACILITY PROVIDER NUMBER
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A NUMBER ISSUED TO A HOSPITAL
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UNDER ASCA, PLANS OTHER THAN MEDICARE?
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MAY ALLOW SUBMISSION OF CLAIMS ON PAPER
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THE NATIONAL UNIFORM CLAIM COMMITTEE IS MADE UP OF?
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AMA REPRESENTATIVES CMS REPRESENTATIVES PROVIDERS
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THE MOST RECENTLY REVISED VERSION OF THE 1500 HEALTH INSURANCE CLAIM FORM DEVELOPED IN 2012 ACCOMODATES?
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CHANGES IN THE ELECTRONIC CLAIMS SUBMISSION VERSION 5010 837P
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HIPAA LAWS REQUIRED THAT THE PROVIDER RENDERING THE SERVICE BE IDENTIFIED ON THE CLAIM FORM BY?
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REPORTING THE CORRECT PROVIDER NUMBER
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OBRA REQUIRES MEDICARE ADMINISTRATIVE CONTRACTS TO?
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PAY INTEREST ON ALL CLEAN CLAIMS NOT PAID ON TIME
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A CLAIM THAT IS INVESTIGATED ON A POSTPAYMENT BASIS THAT IS FOUND TO BE "NOT DUE" WILL REQUIRE?
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REFUND OF MONIES PAID
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IF THERE IS A BALANCE REMAINING ON ACCOUNT AFTER PRIMARY INSURANCE HAS PAID, AND THE PATIENT HAS SECONDARY COVERAGE, THE BILLING SPECIALIST SHOULD?
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SEND A CLAIM FORM TO THE SECONDARY INSURANCE WITH A COPY OF EOB FROM PRIMARY CARRIER
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NATIONAL PROVIDER IDENTIFICATION NUMBERS ARE USED TO REPORT?
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REFERRING PHYSICIANS ORDERING PHYSICIANS PERFORMING PHYSICIANS
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NATIONAL PROVIDER IDENTIFICATION NUMBERS ARE ASSIGNED?
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ONCE IN A LIFETIME, PER HEALTH CARE PROVIDER
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TO CORRECT A CLAIM THAT HAS BEEN DENIED BECAUSE OF AN INVALID PROCEDURE CODE, THE BILLING SPECIALIST SHOULD?
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CONFIRM THE CODE IN CPT MANUAL TO ENSURE IT IS VALID FOR THE DATE OF SERVICE
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TO CORRECT A CLAIM THAT WAS DENIED BECAUSE MORE THAN SIX LINES WERE ENTERED ON THE CLAIM...
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BILL SIX CLAIM LINES ON ONE CLAIM AND COMPLETE AN ADDITIONAL PAPER CLAIM FOR THE ADDITIONAL CLAIM LINES
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CMS 1500 (02-12) DEVELOPED BY?
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NATIONAL UNIFORM CLAIM COMMITTEE (NUCC)
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TRUE OR FALSE? IT IS NOT RECOMMENDED TO LET PATIENTS DIRECT THEIR OWN FORMS TO INSURANCE COMPANIES OR EMPLOYERS?
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TRUE
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TRUE FALSE? FOR BILLING PURPOSES, GENERALLY THE PRIMARY POLICY IS THE POLICY HELD BY THE PATIENT WHEN THE PATIENT AND HIS OR HER SPOUSE ARE BOTH COVERED BY EMPLOYER-PAID INSURANCE. EX: SPOUSES ARE ON EACHOTHERS INSURANCE, WIFE GOES TO HOSPITAL, HER INSURANCE, (SHE IS SUBSCRIBER) IS PRIMARY.
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TRUE
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HOW MANY DIGITS MUST BE USED FOR DATES OF SERVICE?
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6 DIGIT OR 8 DIGIT
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WHAT NUMBER PAYS BECAUSE IT IS UNIVERSAL?
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NPI NUMBER
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DON'T HANDWRITE INFORMATION ON DOCUMENT. HANDWRITING IS ONLY ACCEPTED FOR SIGNATURES
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DON'T FOR CLAIM COMPLETION
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DON'T ALLOW CHARACTERS TO TOUCH LINES
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DON'TS FOR CLAIM COMPLETION
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DON'T USE BROKEN CHARACTERS (SCRIPT, SLANT, MINIFONT, BOLD FONT) USE FONTS THAT HAVE THE SAME WIDTH FOR EACH CHARACTER
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DON'TS FOR CLAIM COMPLETION
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WHAT ARE THE TWO TYPES OF CLAIMS SUBMITTED TO INSURANCE COMPANIES FOR PAYMENT?
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ELECTRONIC AND PAPER
