Deck 11: Essential Cms-1500 Claim Instructions

Question 1

Hospital inpatient charges are reported on the __________ claim.

A) CMS-1500
B) UB-92
C) UB-02
D) UB-04

Answer 1

UB-04

Question 2

When reporting procedures and services on the CMS-1500, list one procedure per line, starting with line one of Block 24. To report more than six procedures or services for the same date of service, __________.

A) enter multiple codes on the same line in Block 24
B) generate a new claim to enter more procedures/services
C) increase the number of units entered in Block 24G
D) use the shaded lines in Block 24 of the first CMS-1500

Answer 2

generate a new claim to enter more procedures/services

Question 3

Diagnosis pointer letters A-L are preprinted in Block 21 of the CMS-1500 claim to allow for entry of __________ codes, and they are reported in Block 24E.

A) CPT
B) HCPCS level II
C) ICD-10-CM
D) ICD-10-PCS

Answer 3

ICD-10-CM

Question 4

The optical scanning process uses a device that converts __________ characters into text that can be viewed by an optical character reader (OCR).

A) electronic
B) encrypted
C) manual
D) printed

Question 5

When entering a fee in Blocks 24F, 28, or 29, enter __________ in the cents column.

A) 1 zero
B) 2 zeros
C) 3 zeros
D) no zeros

Question 6

Surgeon's charges for inpatient and outpatient surgery are billed according to a global fee, which means that __________ cover(s) presurgical evaluation and management, initial and subsequent hospital visits, surgical procedure, the discharge visit, and uncomplicated postoperative follow-up care in the surgeon's office.

A) multiple charges
B) one charge
C) separate charges
D) unit-based charges

Question 7

Which of the following health care professionals is permitted to bill a physician when that physician provides direct supervision of procedures/services?

A) medical assistant
B) nonphysician practitioner
C) nurse
D) pharmacist

Question 8

Which occurs when a physician in the community refers a patient to the hospital for observation, bypassing the clinic or emergency department?

A) direct admission
B) emergency admission
C) outpatient admission
D) referred admission

Question 9

Provider services for inpatient care are billed on a fee-for-service basis, and service results in a unique and separate charge designated by a __________ or HCPCS level II service/procedure code.

A) CPT
B) ICD-9-CM
C) ICD-10-CM
D) ICD-10-PCS

Question 10

Postoperative complications requiring a return to the operating room for surgery related to the original procedure are billed as an additional procedure, and the additional procedure is linked to __________.

A) a new diagnosis that describes the complication
B) an appropriate CPT or HCPCS level II modifier
C) the diagnosis as the reason for original surgery
D) surgical staff that performed the new procedure

Question 11

Block 33 of the CMS-1500 claim requires entry of the name, address, and telephone number of the billing entity, which is the __________.

A) last name of the provider who applied for an EIN
B) legal business name of the practice
C) name of the provider who started the practice
D) provider who treats the most patients

Question 12

Supplemental plans usually cover the deductible and copay or coinsurance of a primary health insurance policy. Which is the best known supplemental plan?

A) Medicaid
B) Medigap
C) Medicare
D) TRICARE

Question 13

Which was developed by the Centers for Medicare and Medicaid Services to assign the unique health care provider and health plan identifiers and to serve as a database from which to extract data?

A) DOD OIG
B) HIPAA
C) ICD-10-CM
D) NPPES

Question 14

Patients sign Block 13 of the CMS-1500 claim to instruct the payer to directly reimburse the provider. This concept is called __________.

A) accept assignment
B) assignment of benefits

Question 15

When completing the CMS-1500, enter a __________ for the dollar sign or decimal in all charges or totals and parentheses surrounding the area code in a telephone number.

A) dash
B) hyphen
C) period
D) space

Question 16

The CMS-1500 paper claim was designed to accommodate optical scanning of __________ claims.

A) electronic
B) encrypted
C) manual
D) paper

Question 17

Which is considered a nonphysician practitioner?

A) nurse
B) pharmacist
C) physician assistant
D) provider

Question 18

Which is a licensed physician in good standing who, according to state regulations, engages in the direct management of nonphysician practitioners whose duties are encompassed by that physician's scope of practice?

A) attending physician
B) managing physician
C) primary care physician
D) supervising physician

Question 19

HIPAA regulations require all payers to accept __________ attachments.

A) electronic
B) encrypted
C) manual
D) paper

Question 20

When a person uses a title such as Sr., Jr., II, or III, __________.

A) always include it after entry of the person's last name on the CMS-1500 claim
B) do not enter it on the claim unless printed on the patient's insurance ID card
C) enter the title on the claim if instructed to do so by the patient or beneficiary
D) verify the use of the title with the patient or guarantor before entering on the claim

Question 21

The MUE project was implemented by CMS as part of the NCCI to improve the accuracy of Medicare payments by __________.

A) comparing units of service with payment requested on submitted claims
B) detecting and denying unlikely Medicare claims on a prepayment basis
C) reimbursing submitted claims within 30 days of receipt and adjudication
D) reporting errors due to inappropriate units of service, reducing overpayments

Question 22

Secondary diagnoses codes are entered in Blocks __________ of the CMS-1500 claim.

A) 21B - 24L
B) 24E

Question 23

ICD-10-CM diagnosis codes are entered in Block 21 of the CMS-1500 claim. A maximum of __________ ICD-10-CM codes may be entered on a single claim.

A) 4
B) 8
C) 12
D) 16

Question 24

The code reported in Block 21A of the CMS-1500 claim is the major reason the patient was treated by the health care provider. It is called the __________ diagnosis.

A) comorbid
B) first-listed
C) primary
D) principal

Question 25

Diagnoses must be entered in the patient's record to validate __________ of procedures or services billed.

A) documentation
B) frequency
C) medical necessity
D) submission

Question 26

When the YES box in Block 27 of the CMS-1500 claims contains an X, the provider agrees to receive as payment in full whatever the payer reimburses. This concept is called __________.

A) accept assignment
B) assignment of benefits

Question 27

When entering codes for diagnoses on a CMS-1500 claim, qualified diagnosis codes (e.g., possible, probable) are never reported. Instead, codes for the patient's __________ are entered.

A) acute conditions
B) chronic diagnoses
C) laboratory tests
D) signs or symptoms