Deck 15: Filing the Claim Form

Question 1

Coordination of benefits is when the insurance carrier determines if care given was appropriate for place of service and diagnosis submitted for services rendered.

Answer 1

False

Question 2

If your physician is non-PAR with Aetna and you need to obtain copies of their payment policies and procedures, you can request these from Aetna either in writing or via phone and they will send them directly to the physician.

Answer 2

False

Question 3

Each checked or circled CPT service on the encounter form needs to clearly indicate the ICD-9 code that correlates to it. This is called matching.

Answer 3

False

Question 4

A typical form for capturing charges and codes for office services is the router form.

Question 5

Insurance cards should be copied how often?

A) Each January when new cards are issued
B) At each visit
C) Every other visit
D) Only when the patient informs you of insurance changes

Question 6

If an insurance plan considers the planned care to be a non-covered benefit, the patient is to sign an ABN _______.

A) upon receiving the denial from the carrier
B) prior to receiving the treatment
C) when they come back for follow-up
D) after receiving treatment

Question 7

Birth dates are not required for the patient and spouse to determine whose insurance plan is responsible for payment.

Question 8

On the CMS claim form, the date of birth format is listed as 03/20/32.

Question 9

Payments to the organization from any payer may vary and come in electronic format or check.

Question 10

A Medicare patient is obligated to pay 20% of what Medicare allows for each service in addition to a ____.

A) coinsurance
B) co-payment
C) deductible
D) out-of-pocket fee

Question 11

Upcoding is selection of a code higher than supported by physician documentation.

Question 12

HIPAA requires insurance plans and clearinghouses to use standard rejection codes and descriptions.

Question 13

If a nurse practitioner is seeing patients in the office with no physician on site, the claim is billed as incident to the physician.

Question 14

The provider number and the UPIN are one and the same and can be used interchangeably.

Question 15

It is illegal to waive copays and coinsurances in the physician's office as a professional courtesy.

Question 16

CMS will pay non-PAR physicians 10% lesser rate than PAR physicians.

Question 17

ABNs are used when a planned service is not covered under the carrier plan for Medicare only.

Question 18

Most insurance plans have limitations in coverage such as with preventative services.

Question 19

Verification of insurance eligibility can be done by using the Internet.

Question 20

Government payers include Medicaid, Medicare, Federal Employees, TRICARE, Indian Health Services, and ________.

A) Railroad Retirement
B) Blue Cross/Blue Shield
C) Workers' Compensation
D) Automobile Accident Claims

Question 21

____________________ is payment that medical professionals retroactively receive for services provided.

Question 22

Encounter forms should be updated how often?

A) Quarterly
B) Monthly
C) Twice a year
D) Annually

Question 23

The process of reviewing EOBs, posting payments, and determining if the payment amount is correct is called ____________________.

Question 24

Some physicians are now beginning to carry a ________________________________________ to assist in tracking services provided outside of the office and document codes as well as time.

Question 25

______________________________ has a signed agreement with an insurance carrier to accept insurance as payment in full and does not charge the patient the balance.

Question 26

Concept of a physician not enrolling in Medicare for a specific time period is called ____________________.

Question 27

____________________ is reporting multiple codes rather than submitting one comprehensive code that describes the entire service.

Question 28

Physicians are reimbursed for professional services by the _________.

A) Balanced Budget Act
B) RBRVS
C) Outpatient PPS
D) ICD codes

Question 29

The _________________________ prohibits knowingly submitting false claims to government payers and/or submission of false records or statements to avoid an obligation to pay money to the government.

Question 30

Explain the role of the electronic medical record used in a physician office. Discuss the advantages and disadvantages and the impact on documentation.

Question 31

UPIN is an acronym for _______.

A) Unique Provider Identifier Number
B) Unique Payer Identification Number
C) Unique Physician Identifier Number
D) Unique Participant Identifier Number

Question 32

List four steps for and/or elements that must be documented when completing an ABN.