Exam 11: Physician Medical Billing

On the CMS-1500 claim form, the abbreviation NPI indicates that: A)a condition was Not Present or Indicated upon examination. B)the National Health Plan Identifier must be entered. C)the National Provider Identifier must be entered. D)the National Preferred Identifier for clearinghouses must be entered.

The individual who purchases an insurance policy is known as the: A)employee. B)guarantor. C)patient. D)policyholder.

On the CMS-1500 claim form, the abbreviation EMG indicates that: A)an employer identifier number must be entered. B)it must be noted if emergency services were provided. C)it must be noted if preauthorization was obtained. D)it must be noted if the service is considered emerging or experimental.

The identification number issued to physicians who are authorized to practice medicine in a given state is the: A)Social Security number. B)Federal Tax Identification number. C)state license number. D)Employer Identification Number.

Place of service codes used in form locator 24B include all of the following EXCEPT: A)private residence. B)urgent care facility. C)operating room. D)independent laboratory.

Most physicians bill insurance carriers by completing paper or electronic versions of which form? A)Verification of benefits form B)CMS-1500 claim form C)UB-04 claim form D)Superbill

The CMS-1500 claim form is mandatory for all Medicare claims.

The majority of income received by a medical facility comes from patients.

As it pertains to the CMS-1500 form, the acronym OCR refers to: A)the Office of Civil Rights. B)optical character recognition. C)optional code references. D)optical CPT recognition.

If a patient wishes insurance payments to be made directly to the provider, the patient must sign which type of form? A)Assignment of benefits form B)Explanation of benefits form C)Patient information form D)Release of information form

According to the birthday rule, if both parents cover dependent children under their insurance policies, the primary insurance is the policy: A)that has been in force the longest. B)of the older parent. C)of the parent whose date of birth occurs earliest in the year. D)that has the highest level of benefits.

If form locator 20 is marked Yes because the physician referred the patient to an outside lab for some type of lab work, form locator 32 must also be completed.

If more than one physician is involved in a case, what priority order is used to determine the physician listed in form locator 17? A)Ordering Provider, Referring Provider, Supervising Provider B)Referring Provider, Supervising Provider, Ordering Provider C)Supervising Provider, Ordering Provider, Referring Provider D)Referring Provider, Ordering Provider, Supervising Provider

On universal claim forms for physician or hospital services, a form locator is a number printed on the form that serves as a unique identifier.

The source document used by a medical office specialist to enter patient encounter data into a computerized accounting system is the superbill.

The subsection of HIPAA that regulates electronic billing is known as the:

A company that provides data processing and claims processing services to medical practices is a(n): A)billing service. B)independent auditing firm. C)clearinghouse. D)third-party administrator.

A limited insurance policy purchased to cover part of the patient's expenses, such as coinsurance, for which the patient would otherwise be responsible, is: A)secondary insurance. B)supplemental insurance. C)additional insurance. D)optional insurance.

When health claims information is exchanged electronically, both the sender and the receiver must follow what HIPAA transaction standard? A)5010 B)CMS-1500 C)OCR D)EMC

On the CMS-1500 claim form, the abbreviation MM indicates that: A)more than one area of malignancy was located. B)multiple tests were performed. C)the month should be entered as two digits. D)more information is needed before a diagnosis can be determined.