Deck 17: The Immune System

Question 1

How many digits are in a National Provider Identifier (NPI) number?

A) 18
B) 10
C) 9
D) 5

Answer 1

10

Question 2

Electronically processing claim forms to insurance carriers:

A) lengthens the turnaround time
B) reduces the amount of preparation time for the claims processor
C) is discouraged because of the danger of violating HIPAA
D) is more expensive than traditional manual claims processing

Answer 2

reduces the amount of preparation time for the claims processor

Question 3

Manual claims tracking:

A) frequently causes payment delays
B) requires minimal effort on the part of office staff
C) is both inexpensive and efficient
D) is commonly used in most practices today

Answer 3

frequently causes payment delays

Question 4

Match each type of information found on an Explanation of Benefits (EOB) form with its definition.
Amount of money a patient owes as a share of the bill

A)patient
B)insured ID number
C)claim number
D)type of service
E)date of service
F)charge
G)not covered amount
H)total patient cost

Question 5

When a third-party payer identifies an error on the claim form, the claim is:

A) rejected with a request to resubmit the form with corrections
B) rejected and barred from resubmission
C) paid, with a penalty fee subtracted for the error
D) held indefinitely until the medical office calls to inquire about its status

Question 6

When applying an insurance adjustment to a patient's account, you are not typically required to post the:

A) name of the insurance company making the adjustment
B) name of the secondary insurance company that might be billed later
C) amount of the adjustment
D) date of the adjustment

Question 7

Match each type of information found on an Explanation of Benefits (EOB) form with its definition.
Number that identifies or refers to the claim that either the patient or the health provider submitted to the insurance company

A)patient
B)insured ID number
C)claim number
D)type of service
E)date of service
F)charge
G)not covered amount
H)total patient cost

Question 8

When following up on a delinquent claim, if the carrier tells you that it is still in process, you should:

A) resubmit the claim by mail
B) resubmit the claim by fax
C) send the patient a statement
D) request an anticipated date of payment

Question 9

Match each type of information found on an Explanation of Benefits (EOB) form with its definition.
Amount of money that a patient's insurance company did not pay the provider

A)patient
B)insured ID number
C)claim number
D)type of service
E)date of service
F)charge
G)not covered amount
H)total patient cost

Question 10

What is the first step in completing a claim form?

A) Check to see if the patient's signature is on file for release of information.
B) Write the provider's federal tax ID number in the appropriate space.
C) Correctly complete boxes 1-3 on the form.
D) Check for a photocopy of the patient's insurance card.

Question 11

Which form is also known as the UB-40 form?

A) CMS-1450
B) CMS-1500
C) Explanation of Benefits (EOB) form
D) FCC Form 159-C

Question 12

Since 2005, providers have been urged to:

A) require patients to pay the full balance before leaving the office
B) bill patients directly, requiring them to seek reimbursement on their own
C) send claims manually
D) send claims electronically

Question 13

Which carriers will accept physicians' typed name and credentials as an indication of their signature?

A) Medicare and Medicaid
B) private health insurers
C) no carriers
D) all carriers

Question 14

The phrase _____ was coined to indicate payment of services rendered by someone other than the patient.

A) health care provider
B) health maintenance organization
C) third-party reimbursement
D) two-party system

Question 15

Match each type of information found on an Explanation of Benefits (EOB) form with its definition.
Amount a provider billed the patient's insurance company for a service

A)patient
B)insured ID number
C)claim number
D)type of service
E)date of service
F)charge
G)not covered amount
H)total patient cost

Question 16

The Remittance Advice form is used when payment is being made from:

A) American Medical Association (AMA)
B) American Heart Association (AHA)
C) Medicare
D) Blue Cross Blue Shielf

Question 17

The CMS-1500 form is accepted by:

A) Medicare
B) Medicaid
C) both Medicare and Medicaid
D) neither Medicare nor Medicaid

Question 18

Which of the following is not a fee usually charged by a clearinghouse?

A) start-up fee
B) flat monthly fee
C) customer service fee
D) per-claim transaction fee

Question 19

Match each type of information found on an Explanation of Benefits (EOB) form with its definition.
Beginning and end dates of the health-related service a patient received from a provider

A)patient
B)insured ID number
C)claim number
D)type of service
E)date of service
F)charge
G)not covered amount
H)total patient cost

Question 20

Which of the following is not an advantage of using an Electronic Claims Tracking (ECT) system?

A) Claims can be tracked online.
B) All claims are guaranteed to be paid if the forms are filled out correctly.
C) Far fewer phone calls need to be made to track unpaid claims.
D) The use of 24-hour rolling claims problem alerts reduces lost time.

Question 21

Match each term with its definition.
Form or document that may be sent to the patient by their insurance company several months after they have had a healthcare service that was paid by the insurance company

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB) form
G)Standard Electronic Data Interchange (EDI) Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI) transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT) systems
P)credit balance
Q)secondary insurance

Question 22

Match each type of information found on an Explanation of Benefits (EOB) form with its definition.
Name of the person who received the service

A)patient
B)insured ID number
C)claim number
D)type of service
E)date of service
F)charge
G)not covered amount
H)total patient cost

Question 23

Match each term with its definition.
Patient's signature on a form that permits the release of his or her information, allowing the claim to be filed on his or her behalf

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB) form
G)Standard Electronic Data Interchange (EDI) Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI) transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT) systems
P)credit balance
Q)secondary insurance

Question 24

Match each term with its definition.
Standard claim form used for billing in medical offices

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB) form
G)Standard Electronic Data Interchange (EDI) Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI) transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT) systems
P)credit balance
Q)secondary insurance

Question 25

Match each term with its definition.
The most common of these are federal and state agencies, insurance companies, and workers' compensation

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB) form
G)Standard Electronic Data Interchange (EDI) Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI) transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT) systems
P)credit balance
Q)secondary insurance

Question 26

Match each term with its definition.
Sets forth the very specific requirements a provider must meet in order to submit paper claim forms and receive CMS payment

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB) form
G)Standard Electronic Data Interchange (EDI) Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI) transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT) systems
P)credit balance
Q)secondary insurance

Question 27

Match each term with its definition.
Information on this form is collected to ensure credit for full payment, to ensure the patient receives any refunds due, to service public inquiries, and to comply with the Debt Collection Improvement Act of 1996

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB) form
G)Standard Electronic Data Interchange (EDI) Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI) transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT) systems
P)credit balance
Q)secondary insurance

Question 28

Match each term with its definition.
This amount is often shown in parentheses in a patient account

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB) form
G)Standard Electronic Data Interchange (EDI) Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI) transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT) systems
P)credit balance
Q)secondary insurance

Question 29

Match each type of information found on an Explanation of Benefits (EOB) form with its definition.
Number assigned to a patient by the insurance company, which should match the number on the patient's insurance card

A)patient
B)insured ID number
C)claim number
D)type of service
E)date of service
F)charge
G)not covered amount
H)total patient cost

Question 30

Match each term with its definition.
Use of these allows a medical facility or physician's office to submit transactions faster and be paid sooner

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB) form
G)Standard Electronic Data Interchange (EDI) Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI) transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT) systems
P)credit balance
Q)secondary insurance

Question 31

Match each term with its definition.
Private or public company that often serves as the middleman between providers and billing groups, payers, and other health care partners for the transmission and translation of electronic claims information into the specific format required by payers

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB) form
G)Standard Electronic Data Interchange (EDI) Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI) transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT) systems
P)credit balance
Q)secondary insurance

Question 32

Match each term with its definition.
Authorizes benefits to be paid directly from a third-party payer to a provider

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB) form
G)Standard Electronic Data Interchange (EDI) Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI) transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT) systems
P)credit balance
Q)secondary insurance

Question 33

Match each type of information found on an Explanation of Benefits (EOB) form with its definition.
Code and brief description of the health-related service a patient received from a provider

A)patient
B)insured ID number
C)claim number
D)type of service
E)date of service
F)charge
G)not covered amount
H)total patient cost

Question 34

Match each term with its definition.
Book in which a list of insurance claims is kept

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB) form
G)Standard Electronic Data Interchange (EDI) Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI) transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT) systems
P)credit balance
Q)secondary insurance

Question 35

Match each term with its definition.
Paper claim form that may be submitted by an institutional provider that meets certain requirements

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB) form
G)Standard Electronic Data Interchange (EDI) Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI) transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT) systems
P)credit balance
Q)secondary insurance

Question 36

Match each term with its definition.
Developed to report the health care provided to the source of payment when third-party reimbursement was created

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB) form
G)Standard Electronic Data Interchange (EDI) Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI) transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT) systems
P)credit balance
Q)secondary insurance

Question 37

Match each term with its definition.
These give you immediate access to the status of a claim or group of claims

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB) form
G)Standard Electronic Data Interchange (EDI) Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI) transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT) systems
P)credit balance
Q)secondary insurance

Question 38

Match each term with its definition.
Type of payment used for centuries in the past

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB) form
G)Standard Electronic Data Interchange (EDI) Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI) transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT) systems
P)credit balance
Q)secondary insurance

Question 39

Match each term with its definition.
This must be completed before submitting electronic media claims to Medicare

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB) form
G)Standard Electronic Data Interchange (EDI) Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI) transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT) systems
P)credit balance
Q)secondary insurance

Question 40

Match each term with its definition.
In many instances, this will pay most, if not all, of the balance left over from the primary insurance to your physician and will leave little out-of-pocket expenses for the patient

A)bartered goods
B)claim form
C)third-party reimbursers
D)CMS-1500
E)CMS-1450
F)Explanation of Benefits (EOB) form
G)Standard Electronic Data Interchange (EDI) Enrollment form
H)Remittance Advice form
I)manual insurance log
J)signature on file
K)assignment of benefits clause
L)Electronic Data Interchange (EDI) transactions
M)Administrative Simplification Compliance Act (ASCA)
N)clearinghouse
O)Electronic Claims Tracking (ECT) systems
P)credit balance
Q)secondary insurance