Deck 15: Medical Billing and Reimbursement

Question 1

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

Answer 1

copy

Question 2

The federal tax identification number is found in block __________.

Answer 2

25

Question 3

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

Answer 3

Co-payment

Question 4

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 5

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 6

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

Question 7

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

Question 8

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

Question 9

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

Question 10

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

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

Question 11

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 12

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 13

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

Question 14

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

Question 15

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

Question 16

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 17

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

Question 18

A secondary health plan is noted in which block?

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

Question 19

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 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

Secondary insurance policy information is contained in block __________.

Question 22

Insurance information should be collected on the first visit.

Question 23

Dirty claims cannot be resubmitted.

Question 24

The insurance claim should always be proofread.

Question 25

Only physicians can be providers of medical services.

Question 26

Electronic claims are submitted via electronic media.

Question 27

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

Question 28

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

Question 29

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

Question 30

The primary insurance policy information is contained in block __________.