Question 1

Hospital inpatient charges are reported on the __________ claim.

Accepted Answer

The UB-04 form is used for billing hospital inpatient and outpatient services, including inpatient charges.

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, __________.

Accepted Answer

To report more than six procedures or services for the same date of service, a new claim form should be generated to accommodate the additional 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.

Accepted Answer

The diagnosis pointer letters in Block 21 of the CMS-1500 claim form are used to reference ICD-10-CM diagnosis codes, which are reported in Block 24E to indicate the medical necessity for the services billed.

Question 4

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

Accepted Answer

Optical scanning involves converting printed characters into digital text using an OCR device.

Question 5

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

Accepted Answer

When entering a fee in Blocks 24F, 28, or 29, you should enter 2 zeros in the cents column to represent whole dollar amounts.

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.

Accepted Answer

The global fee covers all of the services listed in the question, so there is only one charge.

Question 7

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

Accepted Answer

Nonphysician practitioners, such as nurse practitioners and physician assistants, can bill under a physician when the physician provides direct supervision, following specific billing guidelines.

Question 8

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

Accepted Answer

Direct admission occurs when a physician refers a patient directly to the hospital for observation or treatment, bypassing the clinic or emergency department.

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.

Accepted Answer

CPT (Current Procedural Terminology) codes are used to designate unique and separate charges for services and procedures in a fee-for-service billing system.

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 __________.

Accepted Answer

The answer of Postoperative complications requiring a return to the...

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 __________.

Accepted Answer

Block 33 of the CMS-1500 claim form requires the legal business name of the practice, as it identifies the billing entity responsible for the claim.

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?

Accepted Answer

Medigap is the best known supplemental plan designed to cover the gaps in Medicare, such as deductibles, copayments, and coinsurance.

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?

Accepted Answer

The National Plan and Provider Enumeration System (NPPES) was developed by the Centers for Medicare and Medicaid Services to assign unique identifiers to health care providers and health plans and to serve as a database for extracting data.

Question 14

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

Accepted Answer

The concept of patients signing Block 13 of the CMS-1500 claim to instruct the payer to directly reimburse the provider is called "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.

Accepted Answer

A space is used in the CMS-1500 form to replace the dollar sign or decimal in charges or totals and to separate the area code from the rest of the telephone number.

Question 16

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

Accepted Answer

The CMS-1500 paper claim form is specifically designed for the submission of paper claims, allowing for optical scanning to process these claims efficiently.

Question 17

Which is considered a nonphysician practitioner?

Accepted Answer

The answer of Which is considered a nonphysician practitioner?
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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?

Accepted Answer

A supervising physician is responsible for overseeing nonphysician practitioners, ensuring their duties align with the physician's scope of practice as per state regulations.

Question 19

HIPAA regulations require all payers to accept __________ attachments.

Accepted Answer

HIPAA regulations require all payers to accept electronic attachments.

Question 20

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

Accepted Answer

The title should only be entered on the claim if it is printed on the patient's insurance ID card to ensure consistency and accuracy in the identification of the patient.

Quiz 11: Essential Cms-1500 Claim Instructions