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mod140 ch7 week3
mod140 ch7 week3
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Signature on file may be indicated on the CMS-1500 claim form when a signed assignment of benefits form is retained in the patient's health record. (True/False)
Medicaid and workers' compensation have adopted the use of the CMS-1500 in all states. (True/False)
A photocopy of the CMS-1500 claim form that is processed by the insurance carrier using scanning equipment is not acceptable. (True/False)
a paper claim is one that is submitted on paper, then optically scanned and converted to electronic form by insurance companies. (True/False)
an insurance company may send a copy service to the physician's office to copy a patient's medical records. (True/False)
Most major insurance companies accept the CMS-1500 claim form to the insurance company. (True/False)
If the patient will oblige, let the patient direct his or her own insurance form to the insurance company. (True/False)
If several services are being billed on the same insurance claim form, you may "ditto" the dates on each line of service below the first line. (True/False)
List all services on the insurance claim form, including "no charge" services. (True/False)
The Health Insurance claim form (CMS-1500) is known as ____.
Universal Claim Form
An insurance Claim form that contains no staples or highlighted areas and on which the bar code area has not been deformed is called ____.
A physically clean claim
An insurance claim submitted with errors is referred to as
a dirty claim
What is the protocol to follow on receiving a request for an attending physician's statement from an insurance company on a patient who has applied for health insurance?
Request a fee from the insurance company before sending the attending physician's statement
If you received a request, accompanied with the correct authorization, asking to abstract medical information from a patient's medical record,
send only the information request
office visits may be grouped on the insurance claim form if each visit
is consecutive, uses the same procedure code, and result in the same fee
OCR is the acronym for
Optical Character Recognition
OCR guidelines for the CMS-1500 claim form OCR guidelines,
it should not be photocopied because it cannot be scanned
How should blocks be treated on an OCR CMS-1500 claim form that do not need any information?
Leave the block blank
The CMS-1500 claim form is divided into which of the following major sections?
Patient and physician information
The health Insurance Claim form, also known as the universal claim form, is often called or referred to as _______
A claim that is submitted to the insurance carrier via a dial-up modem is referred to as ______
When the patient is insured by two companies, the coverage is sometimes referred to as _____ coverage.
A husband and wife both have insurance through their employers, and each had added the spouse to their insurance plans for coverage. If the wife is seen for treatment, then her plan is considered....
An insurance claim that is submitted on paper, including optically scanned claims.
A Medicare claim that is missing required information.
An insurance claim held in suspense due to review or other reason.
An insurance claim that requires investigation and needs further clarification.
An insurance claim that is submitted within the program or policy time limit and correctly completed.
An insurance claim that is submitted via a dial-up modem or direct data entry.
An insurance claim that is submitted with errors.
A Medicare claim that contains complete, necessary information but is illogical or incorrect.
Missing Place of service code
Verify that the place of service is correct for the submitted procedure code(s) and fill in correct service code.
The insurance claim was submitted to the secondary instead of the primary insurer.
Obtain data from patient during the first office visit on which company is the primary insurer.
Patient's name and insured's name are entered as the same when the patient is a dependent
Check for Sr., Jr., correct birth date, and verify the insured
The patient's insurance number is incorrect.
Proofread numbers carefully from source documents
Verify and submit valid modifiers with the correct procedure codes for which they are valid.
Operative report is missing from the insurance claim.
Submit all attachments with patient's name and insurance identification number
Procedure code is invalid.
Refer to the current procedure codebooks and verify the coding system used by the insurance company.
Diagnostic Code is missing.
Refer to an updated diagnostic codebook and review the patient record
Total amounts do not equal itemized amounts charged
total all charges on each claim, recheck the math, and verify amounts with patient account.
Duplicate dates of service are listed
Verify with the patient's medical record that all dates of service are listed and accurate.
What is the patient's diagnosis?
38200 acute supportive otitis media without spontaneous rupture of eardrum
What is the type of history and physical examination recorded for this patient?
Where was the professional service performed?
Who is the referring physician?
Perry Cardi MD
Who is the policyholder of the insurance contract?
Harry N. Forehand
According to OCR guidelines, all information on the CMS-1500 claim form should be typed in uppercase. (True/False)
To conform to CMS-1500 OCR Guidelines
do not fold insurance claim forms when mailing, do not use symbols with data on insurance claim forms, do not strike over errors when making a correction on an insurance claim form.
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