Deck 15: Medical Billing and Reimbursement

Question 1

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.

Answer 1

of the onset of the illness.

Question 2

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

Answer 2

transferring data back and forth between two or more entities.

Question 3

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

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

Answer 3

audit

Question 4

The billing provider's NPI number is placed in block

A) 31.
B) 32.
C) 33a.
D) 33b.

Question 5

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 6

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 7

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 8

The patient's name is found in block

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

Question 9

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 10

A secondary health plan is noted in which block?

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

Question 11

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

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

Question 12

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

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

Question 13

Procedures performed on the patient are found in what block?

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

Question 14

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 15

The physician's signature is located in block

A) 12.
B) 13.
C) 31.
D) 33.

Question 16

The assignment of benefits is located in block

A) 12.
B) 13.
C) 27.
D) 33.

Question 17

The insured's name is found in block

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

Question 18

The physician's office place-of-service code is

A) 9.
B) 10.
C) 11.
D) 12.

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

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 21

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

Question 22

The primary insurance policy information is contained in block __________.

Question 23

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

Question 24

Match block 17 with the appropriate content as it relates to completing the CMS-1500 form. (Select all that apply.)

A) National provider identification number
B) Preauthorization number
C) Date of current illness, injury, or pregnancy
D) Diagnosis or nature of illness or injury
E) Name of referring provider
F) Hospitalization dates related to current services

Question 25

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

Question 26

Only physicians can be providers of medical services.

Question 27

Secondary insurance policy information is contained in block __________.

Question 28

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

Question 29

Dirty claims cannot be resubmitted.

Question 30

Match block 21 with the appropriate content as it relates to completing the CMS-1500 form. (Select all that apply.)

A) National provider identification number
B) Preauthorization number
C) Date of current illness, injury, or pregnancy
D) Diagnosis or nature of illness or injury
E) Name of referring provider
F) Hospitalization dates related to current services

Question 31

Match block 14 with the appropriate content as it relates to completing the CMS-1500 form. (Select all that apply.)

A) National provider identification number
B) Preauthorization number
C) Date of current illness, injury, or pregnancy
D) Diagnosis or nature of illness or injury
E) Name of referring provider
F) Hospitalization dates related to current services

Question 32

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

Question 33

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 34

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

Question 35

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

Question 36

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

Question 37

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 38

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

Question 39

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

Question 40

The federal tax identification number is found in block __________.

Question 41

Electronic claims are submitted via electronic media.

Question 42

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

Question 43

Insurance information should be collected on the first visit.

Question 44

The insurance claim should always be proofread.