Deck 17: Medical Billing and Reimbursement

Question 1

The insured's address in block 7 refers to the __________ address.

A) patient's
B) spouse's
C) policyholder's
D) insurance carrier's

Answer 1

policyholder's

Question 2

The Federal Tax ID number (Box 25)for the provider filing the claim can be presented as

A) Social Security Number (SSN).
B) Employer Identification Number (EIN).
C) National Provider Identification (NPI).
D) Both A and B
E) All of the above

Answer 2

Both A and B

Question 3

Procedures performed on the patient are found in what block?

A) 24a
B) 24b
C) 24d
D) 24e

Answer 3

24d

Question 4

To examine claims for accuracy and completeness before they are submitted is to _________ the claims.

A) correct
B) audit
C) revise
D) reject

Question 5

A secondary health plan is noted in which block?

A) 11a
B) 11b
C) 11c
D) 11d

Question 6

When completing the CMS-1500 Form,which section contains information about the patient and the insured?

A) Section 1
B) Section 2
C) Section 3
D) Section 4

Question 7

How many diagnoses can be reported on the CMS-1500?

A) Two
B) Three
C) Four
D) Six

Question 8

Which of the following is typically documented in the estimation of benefits (EOB)?

A) Patient's deductible
B) Co-insurance
C) Co-payment
D) Both A and B
E) All of the above

Question 9

Patients sign an __________ of benefits form so that the physician will receive payment for services directly.

Question 10

Claims that have errors or omissions that must be corrected and resubmitted to receive reimbursement are called _____________ claims.

A) clean
B) dirty
C) dingy
D) incomplete

Question 11

Which of the following is a common reason why insurance claims are rejected?

A) When a procedure listed is not an insurance benefit
B) Lack of insurance coverage on date of service
C) Not obtaining preauthorization for the service
D) Claim was sent to the wrong insurance plan

Question 12

A(n)__________ claim has been completed accurately and completely.

Question 13

Which of the following is a fixed amount per visit and is typically paid at the time of medical services?

A) Co-payment
B) Deductible
C) Co-insurance
D) Both A and B

Question 14

Block 1 of the CMS-1500 contains what information?

A) Patient's name
B) Insured's name
C) Type of insurance coverage
D) Carrier address

Question 15

Preauthorization specifically determines the dollar amount approved for the medical procedure,while precertification gives the provider approval to render the medical service.

A) Both statements are true.
B) Both statements are false.
C) The first statement is true;the second is false.
D) The first statement is false;the second is true.

Question 16

The date in block 14 is the date

A) of the filing of the claim.
B) of the onset of the illness.
C) the patient signed the claim.
D) the provider signed the claim.

Question 17

Which of the following steps to medical billing should be performed prior to rendering medical services?

A) Verify the patient's eligibility for insurance coverage
B) Collect patient insurance information
C) Code the diagnosis and procedures
D) Complete the CMS-1500 health insurance claim form
E) Both A and B

Question 18

A claim that is missing information and is returned to the provider for correction and resubmission is called a(n)__________ claim.

Question 19

Claims submitted to a(n)__________ are forwarded to individual insurance carriers.

Question 20

Electronic data interchange is

A) transferring data back and forth between two or more entities.
B) sending information to one insurance carrier.
C) sending information to one clearinghouse for processing.
D) None of the above

Question 21

The medical assistant should do everything possible to prevent claim __________.

Question 22

The primary insurance policy information is contained in block __________.

Question 23

The insurance claim should always be proofread.

Question 24

Procedure code modifiers are found in column __________ of block 24.

Question 25

Insurance information should be collected on the first visit.

Question 26

Secondary insurance policy information is contained in block __________.

Question 27

The medical assistant should always follow office __________ for claim review and signatures.

Question 28

Claims that are done by direct billing first go to a clearinghouse.

Question 29

The medical assistant should __________ the front and back of the patient's insurance card.

Question 30

The abbreviation often used in blocks 12,13,and 31 is __________.

Question 31

The federal tax identification number is found in block __________.

Question 32

The charges for procedures are listed in column __________ of block 24.

Question 33

Dirty claims cannot be resubmitted.

Question 34

Electronic claims are submitted via electronic media.