Medical Billing & Coding Chapter 11 &12

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When a patient is seen by his surgeon for postoperative complications, any services provided are

billed as an additional procedure

According to optical scanning guidelines, the punctuation that is acceptable when it is part of the patient's name is a (n)

CMS-1500 paper claim

Birth dates are entered as_________ format on the CMS-1500 claim depending on block instructions.

eight digits

The diagnosis code reported in item 1, Block 21, of the CMS-1500 claim is the

single claim

Items 1-4 in Block 21 of the CMS-1500 claim link the lsted diagnosis codes to their appropriate procedure/service code reported in Block 24. This items are known as diagnosis ______numbes

four

The legal business name of the practice is also called the

billing entity

The unique identifier that CMS will assign to providers as part of HIPPA requirements is called the__________

National Provider Identification (NPI)

The maximum number of CPT and / or HCPCS modifiers that can be reported in Block 24 of the CMS -1500 claim is ___

4-6 0r 6

Block 25 of the CMS-1500 claim requires entry of either the provider's social security number or the _________

EIN

Which character is entered in the boxes of Block 8 of the CMS-1500 claim to indicate patient status?

X

When entering the diagnosis codes in Block 21 of the CMS-1500, which/what is entered instead of the decimal?

codes

A patient whose birthday is January 5, 1965, would be entered on the CMS-1500 as______________

01 05 1965

A total charge of $900 would be entered on the CMS-1500 as

900 00

What is reported in Block 24E of the CMS-1500?

diagnosis pointer numbers

When reporting anesthesia time in Block 24G, how must the time be entered?

1

Provider services for inpatient medical cases are billed on what basis?

Nonphysician Practitioner (NPP)

Which prohibits a payers from notifying a provider about payment or rejections on unassigned claims?

Insurance File Set-Up

Medicare Conditions of Participation (Cop) require providers to maintain copies of government insurance claims and attachments submitted for what period of time?____

5 years

When the patient signs Block 13 of the CMS-1500, allowing payment to go directly to the provider, this is known as ___

SIGNATURE ON FILE

When an "X" is entered in one or more of the YES boxes in Block 10 of the CMS-1500 claim, this may indicate that

Is Patient's Condition Related

When is it appropriate to file a patient's secondary insurance claim?

Filed only after the remmittance generated

An example of a supplement insurance plan is ______

Medigap

Which diagnosis is condered a chronic condition that would always affect patient care?

Diabetes Mellitus

In Block 24G _____ units would be entered based on the following statement: Three-view sinus series.

1

When the patient signs a special form that has been placed in the financial or medical record, it is acceptable to enter what prahse in Block 12 and/or Block 13 of the CMS -1500 claim?

SIGNATURE ON FILE

The "birthday rule" applies when dependent children living at home are covered by ore than one health insurance policy. The primary policy is determined by the parent___

subscribes to a different health insurance plan

The Patient is covered by two health insurance policies, his own employer's group health plan and his spouse's employer's group health plan. Which plan is primary for the Patient?

Commercial Health Insurance

When a patient is covered by a government health program? ( e.g., Medicare ) and an employer group health plan, Which is considered primary

Government Health Program

When a patient is listed as a dependent on her spouse's employer group health plan (EGHP) and is covered by an EGHP of her own, the spouse's plan is considered

Primary

The patient's birth date is January 5, 1967. This is entered in Block 3 of the CMS-1500 claim as________

01 05 1967

When the patient and policyholder are identical, Block 4 of the CMS-1500 claim will contain_______

Insurance Name

For Patients between the ages of 19 and 23 who are named as dependents on a family policy, and who are full-tume students, enter an X in the appropriate box of ___________

8

When an X appears in the YES box in Block 10Aa of the CMS-1500 claim, this indicates____

Employement

Deductibles, copayments, and coinsurance expenses are usually covered by what type of plan?

High Deductible Health Plan

When a patient is referred to a consultant, what is entered in Block 17 of the CMS-1500 claim?

Name of Referring Provider

If laboratory procedures are performed in the provider's office, how is this indicated on the CMS-1500 claim?

Check YES or No by placing an (X) in the center of the box to indicate whether the lab will enter the word NONE in item 11 of the CMS-1500 Form.

If the provider's employer tax identification number (EIN) is unavailable, what is acceptable to enter in Block 25 of the CMS-1500?

Social Security Number (SSN)

Losses to a third party caused by the insured, bu an object owned by the insured, or on premises owned by the insured are covered by________insurance

Liability

The Shaded area in each line of Block 24 is used to enter supplemental information to support reported services if instructed by thepayer to enter such information. Data entry Block 24 is limited to reporting ___services

Dates of

Collision is a type of automobile insurance that pays for

damaged to covered vehicle caused by collision with another objext by automobile accident, a deductible is required

In Block 2 of the CMS-1500, the patient's last name, first name, and middle initial are each separated by a _______

Patient's Name

If the same payer providers both the primary and secondary coverage, submit________

Commmercial Secondary Coverage

When filing commercial insurance claims, what information from a nonPAR provider is required in Block 33 of the CMS-1500?

Billing provider information and PH number

In Which Block on the CMS-1500 is a prior authorization number for a procedures or services entered?

24D

Enter an X in the YES box of Block 27 to indicate that the provider agrees to___

Accept Assignment

Payment for medical treatment of an injury will be denied by the liability payer if______________________

it is determined that there was no third party negligence

Which automobile insurance policy coverage can provide for expenses such as lost earnings, rehabilitation, and child care expenses, regardless of fault?

Personal Injury Protection (PIP)

Disability insurance typically provides what type of compensation to the injured person?

workers

The file claim with a liability payer, which form may serve as a substitute for an insurance claim?

regular patient billing statement

What term decribes the contractual right of a third-party payer to recover healthcare expenses from a liable party?

Healthcare Insurance and Group Healthcare Insurance

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