Deck 7: The Paper Claim: Cms-1500 02-12

Question 1

When medications are considered to be experimental, the claim should be sent to the

A) patient.
B) insurance carrier with a copy of the medication container.
C) insurance carrier with a copy of the invoice from the supply house.
D) insurance carrier and directed to the appeals department.

Answer 1

insurance carrier with a copy of the invoice from the supply house.

Question 2

To conform to CMS-1500 OCR guidelines,

A) do not fold insurance claim forms when mailing.
B) do not use symbols with data on insurance claim forms.
C) do not strike over errors when making a correction on an insurance claim form.
D) all of the above.

Answer 2

all of the above.

Question 3

The appropriate method for entering the date of service (January 4, 2xxx) on a claim form is:

A) 1/4/xx
B) 01042xxx
C) 01-04-xx
D) 01 04 xx

Answer 3

01042xxx

Question 4

Which of the following is a lifetime 10-digit number issued to physicians that replaces all other numbers assigned by various health plans?

A) TIN
B) PIN
C) UPIN
D) NPI

Question 5

Medicare providers who charge patients a fee for supplies and equipment such as crutches, urinary catheters, and walkers must send the claims to

A) their regional fiscal intermediary.
B) a specific DME fiscal intermediary.
C) TRICARE.
D) the patient.

Question 6

OCR is the acronym for

A) open code resource.
B) optical character recognition.
C) optical code recognition.
D) online claim recall.

Question 7

OCR guidelines for the CMS-1500 claim form state

A) it can be photocopied by the physician's office to save the expense of buying huge quantities.
B) it can be submitted with handwritten information.
C) it should not be photocopied because it cannot be scanned.
D) enter all information in lowercase letters.

Question 8

An insurance claim form that contains no staples or highlighted areas and on which the bar code area has not been deformed is called

A) a clean claim.
B) a paper claim.
C) a physically clean claim.
D) an error-free claim.

Question 9

When a patient has dual coverage, the insurance that is considered the primary insurance is

A) based on the subscriber's date of birth.
B) determined by which subscriber's last name comes first in the alphabet.
C) determined by which subscriber has had their insurance policy the longest.
D) generally, the policy held by the patient.

Question 10

ASCA provides exceptions to the Medicare electronic claims submission requirement to ____ providers.

Question 11

Office visits may be grouped on the insurance claim form if each visit

A) is consecutive and uses the same procedure code.
B) is consecutive, uses the same procedure code, and results in the same fee.
C) uses the same diagnosis code.
D) occurs during the same month.

Question 12

The CMS-1500 claim form is divided into which of the following major sections?

A) Diagnosis and procedure information
B) Physician and procedure information
C) Patient and physician information
D) Patient and procedure information

Question 13

In 2012, the CMS-1500 claim form was revised to version 02-12 to accommodate

A) the change in the name of the Health Care Financing Administration.
B) reporting of NPI numbers.
C) ICD-10 diagnosis codes.
D) Optical scanning.

Question 14

An insurance claim submitted with errors is referred to as

A) a dingy claim.
B) a dirty claim.
C) a rejected claim.
D) an incomplete claim.

Question 15

The number issued to physicians by the Internal Revenue Service for income tax purposes is known as:

A) TIN.
B) PIN.
C) UPIN.
D) NPI.

Question 16

The CMS-1500 is known as the

A) COMB-1.
B) basic paper claim.
C) attending physician's statement.
D) electronic claim.

Question 17

When completing a claim form, if any question is unanswerable

A) leave the space blank.
B) use DNA (does not apply).
C) use N/A (not applicable).
D) use NA (not applicable).

Question 18

The uniform claim form task force was replaced by

A) Health Care Financing Administration.
B) Centers for Medicare and Medicaid Services.
C) Health Insurance Association of America.
D) National Uniform Claim Committee.

Question 19

ASCA required

A) all claims sent to Medicaid be submitted electronically.
B) all claims sent to Medicare be submitted electronically.
C) all claims sent to Blue Shield plans be submitted electronically.
D) all of the above.

Question 20

The objective of the Administrative Simplification Compliance Act was to improve the administration of the Medicare program by increased efficiencies resulting from ________.

Question 21

The NUCC is charged with the task of ________ national instructions for completion of the CMS-1500 claim form.

Question 22

Health insurance specialists should be familiar with the paper claim, as there may be occasions where the practice experiences technical _____________ and is unable to submit claims electronically.

Question 23

Abstraction of technical information from patient records may be necessary to support medical ___.

Question 24

Effective ___________, the revised paper claim form (02-12) is required for use by all providers.

Question 25

The CMS-1500 paper claim can be purchased through a medical office supply company or through the ____.

Question 26

For the following questions, refer to the CMS-1500 claim form illustrated in Figure 7-3 of the text.
What is the insured's ID number?

Question 27

The diagnosis field of the CMS-1500 claim form is referred to as Block ___.

Question 28

The paper claim form was revised in 1990 and printed in red ink to allow ______ of claims.

Question 29

A clean claim has no ___ and passes all electronic edits.

Question 30

For the following questions, refer to the CMS-1500 claim form illustrated in Figure 7-3 of the text.
Does the patient have another health insurance plan that would provide secondary coverage?

Question 31

All paper claims that are generated should be ___ for misspelling of patient names.

Question 32

For the following questions, refer to the CMS-1500 claim form illustrated in Figure 7-3 of the text.
Was the condition related to an auto accident?

Question 33

When completing a claim form for a patient who has group insurance coverage, it is important to complete all information regarding the patient's ___.

Question 34

A claim that is submitted to the insurance carrier via Internet connection is referred to as ___.

Question 35

To practice medicine within a state, a physician must obtain a physician's state _____.

Question 36

When a non-physician practitioner sees a patient in the office, while another physician in the practice provides direct supervision, the claim can be billed to Medicare using the physician's NPI, referred to as ______ services.

Question 37

When submitting a letter to an insurance company to explain unusual circumstances that should be considered when processing the claim, it should be sent to the attention of the ______.

Question 38

Copies of submitted claim forms should be maintained in a ticker file and followed up on every ___ days.

Question 39

The paper claim form was revised in 2005 to allow reporting of ___ for physicians.

Question 40

For the following questions, refer to the CMS-1500 claim form illustrated in Figure 7-3 of the text.
Who is the policyholder of the insurance contract?

Question 41

Match the reason that the insurance claim was rejected with the possible solution to the problem.

Patient's name and insured's name are entered as the same when the patient is a dependent.

A)Proofread numbers carefully from source documents.
B)Check for Sr., Jr., correct birth date, and verify the insured.
C)Refer to an updated diagnostic codebook and review the patient record.
D)Verify with the patient's medical record that all dates of service are listed and accurate.
E)Verify that the place of service is correct for the submitted procedure code(s) and fill in correct service code.
F)Refer to the current procedure codebooks and verify the coding system used by the insurance company.
G)Verify and submit valid modifiers with the correct procedure codes for which they are valid.
H)Total all charges on each claim, recheck the math, and verify amounts with the patient account.
I)Obtain data from patient during the first office visit on which company is the primary insurer.
J)Submit all attachments with patient's name and insurance identification number.

Question 42

Match the type of insurance claim with the correct description.

An insurance claim that is submitted on paper, including optically scanned claims.

A)Clean claim
B)Dirty claim
C)Electronic claim
D)Incomplete claim
E)Invalid claim
F)Paper claim
G)Pending claim
H)Rejected claim

Question 43

Match the type of insurance claim with the correct description.

An insurance claim held in suspense due to review or other reason.

A)Clean claim
B)Dirty claim
C)Electronic claim
D)Incomplete claim
E)Invalid claim
F)Paper claim
G)Pending claim
H)Rejected claim

Question 44

Match the type of insurance claim with the correct description.

An insurance claim that requires investigation and needs further clarification.

A)Clean claim
B)Dirty claim
C)Electronic claim
D)Incomplete claim
E)Invalid claim
F)Paper claim
G)Pending claim
H)Rejected claim

Question 45

Match the type of insurance claim with the correct description.

A Medicare claim that is missing required information.

A)Clean claim
B)Dirty claim
C)Electronic claim
D)Incomplete claim
E)Invalid claim
F)Paper claim
G)Pending claim
H)Rejected claim

Question 46

Match the reason that the insurance claim was rejected with the possible solution to the problem.

Operative report is missing from the insurance claim.

A)Proofread numbers carefully from source documents.
B)Check for Sr., Jr., correct birth date, and verify the insured.
C)Refer to an updated diagnostic codebook and review the patient record.
D)Verify with the patient's medical record that all dates of service are listed and accurate.
E)Verify that the place of service is correct for the submitted procedure code(s) and fill in correct service code.
F)Refer to the current procedure codebooks and verify the coding system used by the insurance company.
G)Verify and submit valid modifiers with the correct procedure codes for which they are valid.
H)Total all charges on each claim, recheck the math, and verify amounts with the patient account.
I)Obtain data from patient during the first office visit on which company is the primary insurer.
J)Submit all attachments with patient's name and insurance identification number.

Question 47

Match the reason that the insurance claim was rejected with the possible solution to the problem.

Missing place of service code.

A)Proofread numbers carefully from source documents.
B)Check for Sr., Jr., correct birth date, and verify the insured.
C)Refer to an updated diagnostic codebook and review the patient record.
D)Verify with the patient's medical record that all dates of service are listed and accurate.
E)Verify that the place of service is correct for the submitted procedure code(s) and fill in correct service code.
F)Refer to the current procedure codebooks and verify the coding system used by the insurance company.
G)Verify and submit valid modifiers with the correct procedure codes for which they are valid.
H)Total all charges on each claim, recheck the math, and verify amounts with the patient account.
I)Obtain data from patient during the first office visit on which company is the primary insurer.
J)Submit all attachments with patient's name and insurance identification number.

Question 48

Match the type of insurance claim with the correct description.

An insurance claim that is submitted within the program or policy time limit and correctly completed.

A)Clean claim
B)Dirty claim
C)Electronic claim
D)Incomplete claim
E)Invalid claim
F)Paper claim
G)Pending claim
H)Rejected claim

Question 49

For the following questions, refer to the CMS-1500 claim form illustrated in Figure 7-3 of the text.
Where were the services provided to this patient?

Question 50

For the following questions, refer to the CMS-1500 claim form illustrated in Figure 7-3 of the text.
What is the procedural code that was submitted on this claim form, describing the services provided to this patient?

Question 51

Match the reason that the insurance claim was rejected with the possible solution to the problem.

The insurance claim was submitted to the secondary instead of the primary insurer.

A)Proofread numbers carefully from source documents.
B)Check for Sr., Jr., correct birth date, and verify the insured.
C)Refer to an updated diagnostic codebook and review the patient record.
D)Verify with the patient's medical record that all dates of service are listed and accurate.
E)Verify that the place of service is correct for the submitted procedure code(s) and fill in correct service code.
F)Refer to the current procedure codebooks and verify the coding system used by the insurance company.
G)Verify and submit valid modifiers with the correct procedure codes for which they are valid.
H)Total all charges on each claim, recheck the math, and verify amounts with the patient account.
I)Obtain data from patient during the first office visit on which company is the primary insurer.
J)Submit all attachments with patient's name and insurance identification number.

Question 52

For the following questions, refer to the CMS-1500 claim form illustrated in Figure 7-3 of the text.
What is the treating physician's NPI number?

Question 53

For the following questions, refer to the CMS-1500 claim form illustrated in Figure 7-3 of the text.
What is the date that the symptoms first presented for the condition treated?

Question 54

Match the type of insurance claim with the correct description.

An insurance claim that is submitted via a dial-up modem or direct data entry.

A)Clean claim
B)Dirty claim
C)Electronic claim
D)Incomplete claim
E)Invalid claim
F)Paper claim
G)Pending claim
H)Rejected claim

Question 55

Match the type of insurance claim with the correct description.

A Medicare claim that contains complete, necessary information but is illogical or incorrect.

A)Clean claim
B)Dirty claim
C)Electronic claim
D)Incomplete claim
E)Invalid claim
F)Paper claim
G)Pending claim
H)Rejected claim

Question 56

Match the reason that the insurance claim was rejected with the possible solution to the problem.

Incorrect modifier.

A)Proofread numbers carefully from source documents.
B)Check for Sr., Jr., correct birth date, and verify the insured.
C)Refer to an updated diagnostic codebook and review the patient record.
D)Verify with the patient's medical record that all dates of service are listed and accurate.
E)Verify that the place of service is correct for the submitted procedure code(s) and fill in correct service code.
F)Refer to the current procedure codebooks and verify the coding system used by the insurance company.
G)Verify and submit valid modifiers with the correct procedure codes for which they are valid.
H)Total all charges on each claim, recheck the math, and verify amounts with the patient account.
I)Obtain data from patient during the first office visit on which company is the primary insurer.
J)Submit all attachments with patient's name and insurance identification number.

Question 57

Match the type of insurance claim with the correct description.

An insurance claim that is submitted with errors.

A)Clean claim
B)Dirty claim
C)Electronic claim
D)Incomplete claim
E)Invalid claim
F)Paper claim
G)Pending claim
H)Rejected claim

Question 58

For the following questions, refer to the CMS-1500 claim form illustrated in Figure 7-3 of the text.
What is the diagnosis code that was submitted on this claim form, describing the condition the patient was treated for?

Question 59

For the following questions, refer to the CMS-1500 claim form illustrated in Figure 7-3 of the text.
Who is the physician who treated this patient?

Question 60

Match the reason that the insurance claim was rejected with the possible solution to the problem.

The patient's insurance number is incorrect.

A)Proofread numbers carefully from source documents.
B)Check for Sr., Jr., correct birth date, and verify the insured.
C)Refer to an updated diagnostic codebook and review the patient record.
D)Verify with the patient's medical record that all dates of service are listed and accurate.
E)Verify that the place of service is correct for the submitted procedure code(s) and fill in correct service code.
F)Refer to the current procedure codebooks and verify the coding system used by the insurance company.
G)Verify and submit valid modifiers with the correct procedure codes for which they are valid.
H)Total all charges on each claim, recheck the math, and verify amounts with the patient account.
I)Obtain data from patient during the first office visit on which company is the primary insurer.
J)Submit all attachments with patient's name and insurance identification number.

Question 61

According to OCR guidelines, dollar signs ($) should not be used in the money columns.

Question 62

A dirty claim is one that had coffee spilled on it before it was sent to the insurance carrier.

Question 63

Match the reason that the insurance claim was rejected with the possible solution to the problem.

Procedure code is invalid.

A)Proofread numbers carefully from source documents.
B)Check for Sr., Jr., correct birth date, and verify the insured.
C)Refer to an updated diagnostic codebook and review the patient record.
D)Verify with the patient's medical record that all dates of service are listed and accurate.
E)Verify that the place of service is correct for the submitted procedure code(s) and fill in correct service code.
F)Refer to the current procedure codebooks and verify the coding system used by the insurance company.
G)Verify and submit valid modifiers with the correct procedure codes for which they are valid.
H)Total all charges on each claim, recheck the math, and verify amounts with the patient account.
I)Obtain data from patient during the first office visit on which company is the primary insurer.
J)Submit all attachments with patient's name and insurance identification number.

Question 64

A physically clean claim is one that has all of the necessary information required reported on it.

Question 65

Match the reason that the insurance claim was rejected with the possible solution to the problem.

Duplicate dates of service listed.

A)Proofread numbers carefully from source documents.
B)Check for Sr., Jr., correct birth date, and verify the insured.
C)Refer to an updated diagnostic codebook and review the patient record.
D)Verify with the patient's medical record that all dates of service are listed and accurate.
E)Verify that the place of service is correct for the submitted procedure code(s) and fill in correct service code.
F)Refer to the current procedure codebooks and verify the coding system used by the insurance company.
G)Verify and submit valid modifiers with the correct procedure codes for which they are valid.
H)Total all charges on each claim, recheck the math, and verify amounts with the patient account.
I)Obtain data from patient during the first office visit on which company is the primary insurer.
J)Submit all attachments with patient's name and insurance identification number.

Question 66

Presently, most health care organizations send the majority of their claims on paper.

Question 67

A paper claim is one that is submitted on paper and then optically scanned and converted to electronic form by insurance companies.

Question 68

Match the reason that the insurance claim was rejected with the possible solution to the problem.

Total amounts do not equal itemized amounts charged.

A)Proofread numbers carefully from source documents.
B)Check for Sr., Jr., correct birth date, and verify the insured.
C)Refer to an updated diagnostic codebook and review the patient record.
D)Verify with the patient's medical record that all dates of service are listed and accurate.
E)Verify that the place of service is correct for the submitted procedure code(s) and fill in correct service code.
F)Refer to the current procedure codebooks and verify the coding system used by the insurance company.
G)Verify and submit valid modifiers with the correct procedure codes for which they are valid.
H)Total all charges on each claim, recheck the math, and verify amounts with the patient account.
I)Obtain data from patient during the first office visit on which company is the primary insurer.
J)Submit all attachments with patient's name and insurance identification number.

Question 69

Signature on file may be indicated on the CMS-1500 claim form when a signed assignment of benefits form is retained in the patient's health record.

Question 70

If several services are being billed on the same insurance claim form, you may "ditto" the dates on each line of service below the first line.

Question 71

The AMA was named in the administrative simplification of the HIPAA of 1996 as the authoritative voice regarding national standard content for submission of claims.

Question 72

It is not important for the health insurance specialist to understand how to complete a paper claim.

Question 73

List all services on the insurance claim form, including "no charge" services.

Question 74

Match the reason that the insurance claim was rejected with the possible solution to the problem.

Diagnostic code is missing.

A)Proofread numbers carefully from source documents.
B)Check for Sr., Jr., correct birth date, and verify the insured.
C)Refer to an updated diagnostic codebook and review the patient record.
D)Verify with the patient's medical record that all dates of service are listed and accurate.
E)Verify that the place of service is correct for the submitted procedure code(s) and fill in correct service code.
F)Refer to the current procedure codebooks and verify the coding system used by the insurance company.
G)Verify and submit valid modifiers with the correct procedure codes for which they are valid.
H)Total all charges on each claim, recheck the math, and verify amounts with the patient account.
I)Obtain data from patient during the first office visit on which company is the primary insurer.
J)Submit all attachments with patient's name and insurance identification number.

Question 75

According to OCR guidelines, all information on the CMS-1500 claim form should be typed in uppercase.

Question 76

Most insurance companies accept the CMS-1500 claim form except TRICARE and the Blue Plans.

Question 77

If the patient will oblige, let the patient direct his or her own insurance form to the insurance company.

Question 78

According to OCR guidelines, information may be handwritten on the claim form if necessary.