Question 1

When medications are considered to be experimental, the claim should be sent to the

Accepted Answer

A)  patient. 
B)  insurance carrier with a copy of the medication container. 
C)  insurance carrier with a copy of the invoice from the supply house. 
D)  insurance carrier and directed to the appeals department. 
A)  patient. 
B)  insurance carrier with a copy of the medication container. 
C)  insurance carrier with a copy of the invoice from the supply house. 
D)  insurance carrier and directed to the appeals department.

Question 2

According to OCR guidelines, information may be handwritten on the claim form if necessary.

Accepted Answer

A) True 
 B)False

Question 3

Match the reason that the insurance claim was rejected with the possible solution to the problem.

-The insurance claim was submitted to the secondary instead of the primary insurer.

Accepted Answer

A) Proofread numbers carefully from source documents. 
B) Check for Sr., Jr., correct birth date, and verify the insured. 
C) Refer to an updated diagnostic codebook and review the patient record. 
D) Verify with the patient's medical record that all dates of service are listed and accurate. 
E) Verify that the place of service is correct for the submitted procedure code(s) and fill in correct service code.
F)Refer to the current procedure codebooks and verify the coding system used by the insurance company.
G)Verify and submit valid modifiers with the correct procedure codes for which they are valid.
H)Total all charges on each claim, recheck the math, and verify amounts with the patient account.
I)Obtain data from patient during the first office visit on which company is the primary insurer.
J)Submit all attachments with patient's name and insurance identification number. 
A) Proofread numbers carefully from source documents. 
B) Check for Sr., Jr., correct birth date, and verify the insured. 
C) Refer to an updated diagnostic codebook and review the patient record. 
D) Verify with the patient's medical record that all dates of service are listed and accurate. 
E) Verify that the place of service is correct for the submitted procedure code(s) and fill in correct service code.
F)Refer to the current procedure codebooks and verify the coding system used by the insurance company.
G)Verify and submit valid modifiers with the correct procedure codes for which they are valid.
H)Total all charges on each claim, recheck the math, and verify amounts with the patient account.
I)Obtain data from patient during the first office visit on which company is the primary insurer.
J)Submit all attachments with patient's name and insurance identification number.

Question 4

The diagnosis field of the CMS-1500 claim form is referred to as Block ___.

Accepted Answer

The answer of The diagnosis field of the CMS-1500 claim...

Question 5

ASCA provides exceptions to the Medicare electronic claims submission requirement to ____ providers.

Accepted Answer

The answer of ASCA provides exceptions to the Medicare electronic...

Question 6

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

Accepted Answer

A) True 
 B)False

Question 7

Match the reason that the insurance claim was rejected with the possible solution to the problem.

-Procedure code is invalid.

Accepted Answer

A) Proofread numbers carefully from source documents. 
B) Check for Sr., Jr., correct birth date, and verify the insured. 
C) Refer to an updated diagnostic codebook and review the patient record. 
D) Verify with the patient's medical record that all dates of service are listed and accurate. 
E) Verify that the place of service is correct for the submitted procedure code(s) and fill in correct service code.
F)Refer to the current procedure codebooks and verify the coding system used by the insurance company.
G)Verify and submit valid modifiers with the correct procedure codes for which they are valid.
H)Total all charges on each claim, recheck the math, and verify amounts with the patient account.
I)Obtain data from patient during the first office visit on which company is the primary insurer.
J)Submit all attachments with patient's name and insurance identification number. 
A) Proofread numbers carefully from source documents. 
B) Check for Sr., Jr., correct birth date, and verify the insured. 
C) Refer to an updated diagnostic codebook and review the patient record. 
D) Verify with the patient's medical record that all dates of service are listed and accurate. 
E) Verify that the place of service is correct for the submitted procedure code(s) and fill in correct service code.
F)Refer to the current procedure codebooks and verify the coding system used by the insurance company.
G)Verify and submit valid modifiers with the correct procedure codes for which they are valid.
H)Total all charges on each claim, recheck the math, and verify amounts with the patient account.
I)Obtain data from patient during the first office visit on which company is the primary insurer.
J)Submit all attachments with patient's name and insurance identification number.

Question 8

Which of the following is a lifetime 10-digit number issued to physicians that replaces all other numbers assigned by various health plans?

Accepted Answer

A)  TIN 
B)  PIN 
C)  UPIN 
D)  NPI 
A)  TIN 
B)  PIN 
C)  UPIN 
D)  NPI

Question 9

For the following questions, refer to the CMS-1500 claim form illustrated in Figure 7-3 of the text.
-What is the diagnosis code that was submitted on this claim form, describing the condition the patient was treated for?

Accepted Answer

The answer of For the following questions, refer to the...

Question 10

ASCA required

Accepted Answer

A)  all claims sent to Medicaid be submitted electronically. 
B)  all claims sent to Medicare be submitted electronically. 
C)  all claims sent to Blue Shield plans be submitted electronically. 
D)  all of the above. 
A)  all claims sent to Medicaid be submitted electronically. 
B)  all claims sent to Medicare be submitted electronically. 
C)  all claims sent to Blue Shield plans be submitted electronically. 
D)  all of the above.

Question 11

The NUCC is charged with the task of ________ national instructions for completion of the CMS-1500 claim form.

Accepted Answer

The answer of The NUCC is charged with the task...

Question 12

When completing a claim form, if any question is unanswerable

Accepted Answer

A)  leave the space blank. 
B)  use DNA (does not apply). 
C)  use N/A (not applicable). 
D)  use NA (not applicable). 
A)  leave the space blank. 
B)  use DNA (does not apply). 
C)  use N/A (not applicable). 
D)  use NA (not applicable).

Question 13

Match the reason that the insurance claim was rejected with the possible solution to the problem.

-Duplicate dates of service listed.

Accepted Answer

A) Proofread numbers carefully from source documents. 
B) Check for Sr., Jr., correct birth date, and verify the insured. 
C) Refer to an updated diagnostic codebook and review the patient record. 
D) Verify with the patient's medical record that all dates of service are listed and accurate. 
E) Verify that the place of service is correct for the submitted procedure code(s) and fill in correct service code.
F)Refer to the current procedure codebooks and verify the coding system used by the insurance company.
G)Verify and submit valid modifiers with the correct procedure codes for which they are valid.
H)Total all charges on each claim, recheck the math, and verify amounts with the patient account.
I)Obtain data from patient during the first office visit on which company is the primary insurer.
J)Submit all attachments with patient's name and insurance identification number. 
A) Proofread numbers carefully from source documents. 
B) Check for Sr., Jr., correct birth date, and verify the insured. 
C) Refer to an updated diagnostic codebook and review the patient record. 
D) Verify with the patient's medical record that all dates of service are listed and accurate. 
E) Verify that the place of service is correct for the submitted procedure code(s) and fill in correct service code.
F)Refer to the current procedure codebooks and verify the coding system used by the insurance company.
G)Verify and submit valid modifiers with the correct procedure codes for which they are valid.
H)Total all charges on each claim, recheck the math, and verify amounts with the patient account.
I)Obtain data from patient during the first office visit on which company is the primary insurer.
J)Submit all attachments with patient's name and insurance identification number.

Question 14

Match the reason that the insurance claim was rejected with the possible solution to the problem.

-Missing place of service code.

Accepted Answer

A) Proofread numbers carefully from source documents. 
B) Check for Sr., Jr., correct birth date, and verify the insured. 
C) Refer to an updated diagnostic codebook and review the patient record. 
D) Verify with the patient's medical record that all dates of service are listed and accurate. 
E) Verify that the place of service is correct for the submitted procedure code(s) and fill in correct service code.
F)Refer to the current procedure codebooks and verify the coding system used by the insurance company.
G)Verify and submit valid modifiers with the correct procedure codes for which they are valid.
H)Total all charges on each claim, recheck the math, and verify amounts with the patient account.
I)Obtain data from patient during the first office visit on which company is the primary insurer.
J)Submit all attachments with patient's name and insurance identification number. 
A) Proofread numbers carefully from source documents. 
B) Check for Sr., Jr., correct birth date, and verify the insured. 
C) Refer to an updated diagnostic codebook and review the patient record. 
D) Verify with the patient's medical record that all dates of service are listed and accurate. 
E) Verify that the place of service is correct for the submitted procedure code(s) and fill in correct service code.
F)Refer to the current procedure codebooks and verify the coding system used by the insurance company.
G)Verify and submit valid modifiers with the correct procedure codes for which they are valid.
H)Total all charges on each claim, recheck the math, and verify amounts with the patient account.
I)Obtain data from patient during the first office visit on which company is the primary insurer.
J)Submit all attachments with patient's name and insurance identification number.

Question 15

Copies of submitted claim forms should be maintained in a ticker file and followed up on every ___ days.

Accepted Answer

The answer of Copies of submitted claim forms should be...

Question 16

Match the type of insurance claim with the correct description.

-An insurance claim that is submitted within the program or policy time limit and correctly completed.

Accepted Answer

A) Clean claim 
B) Dirty claim 
C) Electronic claim 
D) Incomplete claim 
E) Invalid claim
F)Paper claim
G)Pending claim
H)Rejected claim 
A) Clean claim 
B) Dirty claim 
C) Electronic claim 
D) Incomplete claim 
E) Invalid claim
F)Paper claim
G)Pending claim
H)Rejected claim

Question 17

For the following questions, refer to the CMS-1500 claim form illustrated in Figure 7-3 of the text.
-Where were the services provided to this patient?

Accepted Answer

The answer of For the following questions, refer to the...

Question 18

Match the type of insurance claim with the correct description.

-An insurance claim that requires investigation and needs further clarification.

Accepted Answer

A) Clean claim 
B) Dirty claim 
C) Electronic claim 
D) Incomplete claim 
E) Invalid claim
F)Paper claim
G)Pending claim
H)Rejected claim 
A) Clean claim 
B) Dirty claim 
C) Electronic claim 
D) Incomplete claim 
E) Invalid claim
F)Paper claim
G)Pending claim
H)Rejected claim

Question 19

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

Accepted Answer

A) True 
 B)False

Question 20

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

Accepted Answer

The answer of The CMS-1500 paper claim can be purchased...

When medications are considered to be experimental, the claim should be sent to the

According to OCR guidelines, information may be handwritten on the claim form if necessary.

Match the reason that the insurance claim was rejected with the possible solution to the problem. -The insurance claim was submitted to the secondary instead of the primary insurer.

The diagnosis field of the CMS-1500 claim form is referred to as Block ___.

ASCA provides exceptions to the Medicare electronic claims submission requirement to ____ providers.

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

Match the reason that the insurance claim was rejected with the possible solution to the problem. -Procedure code is invalid.

Which of the following is a lifetime 10-digit number issued to physicians that replaces all other numbers assigned by various health plans?

For the following questions, refer to the CMS-1500 claim form illustrated in Figure 7-3 of the text. -What is the diagnosis code that was submitted on this claim form, describing the condition the patient was treated for?

ASCA required

The NUCC is charged with the task of ________ national instructions for completion of the CMS-1500 claim form.

When completing a claim form, if any question is unanswerable

Match the reason that the insurance claim was rejected with the possible solution to the problem. -Duplicate dates of service listed.

Match the reason that the insurance claim was rejected with the possible solution to the problem. -Missing place of service code.

Copies of submitted claim forms should be maintained in a ticker file and followed up on every ___ days.

Match the type of insurance claim with the correct description. -An insurance claim that is submitted within the program or policy time limit and correctly completed.

For the following questions, refer to the CMS-1500 claim form illustrated in Figure 7-3 of the text. -Where were the services provided to this patient?

Match the type of insurance claim with the correct description. -An insurance claim that requires investigation and needs further clarification.

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

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

Role of an Insurance Billing Specialist

Compliance, Privacy, Fraud, and Abuse in Insurance Billing

Basics of Health Insurance

Medical Documentation and the Electronic Health Record

Diagnostic Coding

Procedural Coding

The Electronic Claim

Receiving Payments and Insurance Problem Solving

Office and Insurance Collection Strategies

The Blue Plans, Private Insurance, and Managed Care Plans

Medicare

Medicaid and Other State Programs

Tricare and Veterans Health Care

Workers Compensation

Disability Income Insurance and Disability Benefit Programs

Hospital Billing

Seeking a Job and Attaining Professional Advancement

Filters

Exam 7: The Paper Claim: Cms-1500 02-12

When medications are considered to be experimental, the claim should be sent to the

According to OCR guidelines, information may be handwritten on the claim form if necessary.

Match the reason that the insurance claim was rejected with the possible solution to the problem. -The insurance claim was submitted to the secondary instead of the primary insurer.

The diagnosis field of the CMS-1500 claim form is referred to as Block ___.

ASCA provides exceptions to the Medicare electronic claims submission requirement to ____ providers.

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

Match the reason that the insurance claim was rejected with the possible solution to the problem. -Procedure code is invalid.

Which of the following is a lifetime 10-digit number issued to physicians that replaces all other numbers assigned by various health plans?

For the following questions, refer to the CMS-1500 claim form illustrated in Figure 7-3 of the text. -What is the diagnosis code that was submitted on this claim form, describing the condition the patient was treated for?

ASCA required

The NUCC is charged with the task of ________ national instructions for completion of the CMS-1500 claim form.

When completing a claim form, if any question is unanswerable

Match the reason that the insurance claim was rejected with the possible solution to the problem. -Duplicate dates of service listed.

Match the reason that the insurance claim was rejected with the possible solution to the problem. -Missing place of service code.

Copies of submitted claim forms should be maintained in a ticker file and followed up on every ___ days.

Match the type of insurance claim with the correct description. -An insurance claim that is submitted within the program or policy time limit and correctly completed.

For the following questions, refer to the CMS-1500 claim form illustrated in Figure 7-3 of the text. -Where were the services provided to this patient?

Match the type of insurance claim with the correct description. -An insurance claim that requires investigation and needs further clarification.

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

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

Role of an Insurance Billing Specialist

Compliance, Privacy, Fraud, and Abuse in Insurance Billing

Basics of Health Insurance

Medical Documentation and the Electronic Health Record

Diagnostic Coding

Procedural Coding

The Electronic Claim

Receiving Payments and Insurance Problem Solving

Office and Insurance Collection Strategies

The Blue Plans, Private Insurance, and Managed Care Plans

Medicare

Medicaid and Other State Programs

Tricare and Veterans Health Care

Workers Compensation

Disability Income Insurance and Disability Benefit Programs

Hospital Billing

Seeking a Job and Attaining Professional Advancement

Filters