Deck 14: Billing and Collections

Question 1

Claims are classified as to their status upon submission to an insurance carrier as clean, dirty, incomplete, rejected, or _______.

A) questionable
B) pending
C) complete
D) incorrect

Answer 1

pending

Question 2

An incentive to physicians to participate with Medicare is faster claims payment.

Answer 2

True

Question 3

Medicare patients typically have secondary (supplemental) coverage with ______________________________.

Answer 3

Medi-Gap

Question 4

Families of active duty military are required to seek care at a military facility. In the event that a service cannot be provided there and the recipient must go to a private facility, a ______________________________ is required.

Question 5

On the CMS 1500, there are six lines available for CPT/HCPCS codes and six lines for diagnosis codes.

Question 6

A medical condition under active treatment at the time application is made for an insurance policy which may not be a covered service under the insurance policy is called a ______________________________.

Question 7

Assigned by the IRS to each physician for income tax purposes

A) National Provider ID
B) Employer Identification Number
C) Social Security Number
D) Payer ID
E) Unique Provider Number
F) Group number
G) PIN
H) Durable Medical Equipment Number

Question 8

A copy of ____ must be sent with a secondary claim in order to process the claim.

A) Discharge Summary
B) OP note
C) Remittance Advice
D) Original claim form

Question 9

____ is the specified dollar amount the patient must pay the provider for each visit.

A) Coinsurance
B) Copayment
C) Charge
D) Deductible

Question 10

Also referred to as Tax ID Number

A) National Provider ID
B) Employer Identification Number
C) Social Security Number
D) Payer ID
E) Unique Provider Number
F) Group number
G) PIN
H) Durable Medical Equipment Number

Question 11

______________________________ is a ruling in an insurance policy when a patient has two or more insurance polices where benefits combined will not exceed 100% of the covered benefit

Question 12

The total amount the patient must pay for covered services before insurance benefits are payable is called a ____________________.

Question 13

Advanced Beneficiary Notices are strictly for use with Medicare patients when a service may not be considered medically necessary.

Question 14

The ____ authorization allows the insurance company to pay the physician directly for services.

A) HIPAA
B) Assignment of Benefits
C) Release of equity
D) Waiver of liability

Question 15

A ____ physician is a physician or non-physician who requests an item or service for a beneficiary such as a consultation, surgery, diagnostic testing, or durable medical equipment and whose name goes in block 17 of the claim form.

A) consulting
B) covering
C) referring
D) treating

Question 16

Medicare Part A covers ambulatory encounters in physician offices, physical therapy, ambulance services, etc.

Question 17

A patient whose Medicare claim number ends with "A" will have the same social security number and claim number.

Question 18

Which of the following providers do not have to accept assignment from Medicare?

A) Ambulance services
B) Clinical diagnostic laboratories
C) Physician assistants
D) Physicians

Question 19

Medicare is a secondary payer when the patient is also covered by a working spouse's insurance.

Question 20

The 8-digit identifier number for Medicare claim forms with a 2-digit location identifier

A) National Provider ID
B) Employer Identification Number
C) Social Security Number
D) Payer ID
E) Unique Provider Number
F) Group number
G) PIN
H) Durable Medical Equipment Number

Question 21

List three common errors that cause delays in claims processing.

Question 22

Used for physician performing a service in a practice that submits claims to carriers

A) National Provider ID
B) Employer Identification Number
C) Social Security Number
D) Payer ID
E) Unique Provider Number
F) Group number
G) PIN
H) Durable Medical Equipment Number

Question 23

Assigned by CMS to a physician as an ID on Medicare claim forms

A) National Provider ID
B) Employer Identification Number
C) Social Security Number
D) Payer ID
E) Unique Provider Number
F) Group number
G) PIN
H) Durable Medical Equipment Number

Question 24

Used for Medicare providers who supply and charge for items such as catheters, crutches, etc.

A) National Provider ID
B) Employer Identification Number
C) Social Security Number
D) Payer ID
E) Unique Provider Number
F) Group number
G) PIN
H) Durable Medical Equipment Number

Question 25

Assigned to identify all third-party payers on claim forms

A) National Provider ID
B) Employer Identification Number
C) Social Security Number
D) Payer ID
E) Unique Provider Number
F) Group number
G) PIN
H) Durable Medical Equipment Number

Question 26

Provider identification number assigned to provider by an insurance company used on all claims filed by the provider

A) National Provider ID
B) Employer Identification Number
C) Social Security Number
D) Payer ID
E) Unique Provider Number
F) Group number
G) PIN
H) Durable Medical Equipment Number