Deck 21: The Health Insurance Claim Form

Question 1

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 1

transferring data back and forth between two or more entities

Question 2

Medicare's UPIN stands for _______ identification number.

A)universal physician
B)unique physician
C)unique provider
D)universal provider

Answer 2

unique provider

Question 3

The transaction and code sets for the CMS-1500 are called the:

A)837P
B)837CMS
C)837HPA
D)837

Answer 3

837P

Question 4

Audit trails are not necessary in the physician's office and are usually used in hospitals.

Question 5

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

Question 6

The insurance claim should always be proofread.

Question 7

The insured's name is found in block:

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

Question 8

Electronic or digital signatures are scanned and accepted as proof of approval for the content of an electronic document.

Question 9

The medical assistant should do the following when a new patient comes to the office?

A)Collect the completed patient information sheet
B)Make a copy of the patient's insurance card, front and back
C)Make a copy of the patient's driver's license
D)All of the above should be done.

Question 10

Electronic claims are submitted via electronic media.

Question 11

Verification of insurance benefits is usually done by:

A)requesting a letter of eligibility from the carrier
B)calling the insurance carrier
C)calling the patient's employer
D)asking the patient the effective date

Question 12

TRICARE is a form of government insurance for veterans of the U.S.armed forces.

Question 13

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 14

Only physicians can be providers of medical services.

Question 15

A claim that is printed and mailed to the carrier is called a ______ copy.

A)soft
B)file
C)hard
D)paper

Question 16

The current Health Care Claim Form has also been called:

A)HCFA 1500
B)Universal Claim Form
C)CMS-1500
D)all of the above

Question 17

Insurance information should be collected on the first visit.

Question 18

Dirty claims cannot be resubmitted.

Question 19

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

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

Question 20

The address of the payer can consist of up to four lines.

Question 21

The information in which block influences which insurance carrier should be billed for the procedures?

A)3
B)8
C)10
D)13

Question 22

The physician's signature is located in block:

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

Question 23

Intelligent __________ is the electronic scanning of printed items as images and the use of special software to read those images.

Question 24

A(n) __________ trail helps identify action taken on insurance claims.

Question 25

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

Question 26

The billing provider's NPI number is placed in block:

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

Question 27

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

Question 28

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

Question 29

Which of the following would be a valid number for block 24e?

A)3
B)6
C)401.1
D)256.01

Question 30

What is meant by "other insured" on the claim form?

A)The spouse of the patient
B)The insured who covers the patient on his or her insurance plan
C)The patient's other insurance
D)The patient who covers the insured on his or her insurance plan

Question 31

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 32

Hard copies of claims are also called __________ claims.

Question 33

Procedures performed on the patient are found in what block?

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

Question 34

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

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

Question 35

A secondary health plan is noted in which block?

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

Question 36

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

Question 37

The assignment of benefits is located in block:

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

Question 38

The patient's name is found in block:

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

Question 39

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 40

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

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

Question 41

__________ identification numbers are issued by individual carriers for use in claims submissions.

Question 42

__________ insurance carriers can be billed using the CMS-1500 claim form.

Question 43

The __________ identification number is used by the Internal Revenue Service.

Question 44

The CMS-1500 claim form is sometimes called a(n) __________ claim form.

Question 45

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

Question 46

All __________ letters should be used on claim forms.

Question 47

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

Question 48

The primary insurance policy information is contained in block __________.

Question 49

The provider can list up to __________ diagnoses on the CMS-1500 claim form.

Question 50

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

Question 51

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

Question 52

Nothing should be __________ to claim forms.

Question 53

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

Question 54

The federal tax identification number is found in block __________.

Question 55

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

Question 56

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

Question 57

Secondary insurance policy information is contained in block __________.