Exam 11: Physician Medical Billing

The person who is ultimately responsible for paying for medical services is known as the __________ .

On the CMS-1500 claim form, the abbreviation DD indicates that: A)up to two diagnosis codes can be entered. B)a doctor of dentistry performed the service. C)the day of the month should be entered as two digits. D)durable medical equipment (DME) was ordered.

The form that allows an insurance company to make payments directly to a physician on behalf of the patient is the __________ form.

Clearinghouses charge providers based on which type of payment system? A)A percentage of each claim's dollar value B)A flat fee per claim C)Per diem D)Per membership per month

A claim can only be submitted to an insurance carrier on the patient's behalf if the patient has signed a(n): A)assignment of benefits form. B)explanation of benefits form. C)patient information form. D)release of information form.

The form used by the provider to document ICD-9-CM and CPT codes for routine services is referred to as a(n): A)encounter form. B)charge slip. C)superbill. D)all of the above.

According to HIPAA, covered entities include health plans, clearinghouses, and healthcare providers.

The scrambling of information during electronic claims submission to prevent it from being read by unauthorized individuals is known as __________ .

In what type of situation must an attachment be submitted with a claim?

A company that receives claims from providers, audits them, and forwards them on to insurance carriers is a(n): A)billing service. B)independent auditing firm. C)clearinghouse. D)third-party administrator.

Why does no standardized superbill form exist?

ICD-9 codes in form locator 21 should be listed in order of precedence with number 1 being the primary diagnosis.

A claim that is missing information or contains incorrect information is referred to as a(n) __________ claim.

Components of the Administration Simplification subsection of HIPAA include all of the following EXCEPT: A)transaction and code sets. B)compliance and auditing guidelines. C)uniform identifiers. D)privacy and security rules.

Electronic claims are entered into a computer system and then printed out to be filed in the patient's medical record.

The place of service code is mandatory for all claims submitted to Medicare.

What is meant by coordination of benefits (COB)?

The policy in most medical offices is to request that the patient sign and update a release of information form: A)at every visit. B)once per year. C)every 2 years. D)every 3 years.

An advantage of filing claims electronically is: A)lower administrative costs. B)fewer claim rejections. C)faster payment. D)all of the above.

The form that specifies which information from the medical chart may be released and to whom is a(n) __________ form.