Chapter 12 med coding and billing

Which of the following refers to the contractual right of a third-party payer to recover healthcare expenses from a liable party?

d. subrogation

Nancy White's employer provides individual and family group health plan coverage, and it pays 80 percent of her annual premium. Nancy selected family coverage for her group health plan, which means her employer pays $12,000 per year (of the $15,000 annual premium). Nancy is responsible for the remaining $3,000 of the annual premium, which means approximately ________ is deducted from each of her 26 biweekly paychecks.

a. $115

The base period used to calculate an individual's weekly disability benefit amount usually covers:

a. 12 months and is divided into four consecutive quarters

A 10-digit-NPI number for the provider who performed the service should be entered where on CMS-1500?

a. Block 24J

When a patient is covered by a large employer group health plan (EGHP) and Medicare, which is primary?

a. EGHP

Block 33a of the CMS-1500 claim contains the provider's

a. NPI

An individual may be found ineligible for disability benefits if they fail to have an independent medical exam.

a. True

Commercial health insurance covers the medical expenses of individuals and groups.

a. True

Disability insurance generally does not pay for health care services, but provides the disabled person with financial assistance.

a. True

Group health insurance can be available through labor unions, rural. and consumer health cooperatives.

a. True

Individuals may be found ineligible for disability benefits if they are in jail, prison, or a recovery home because of a convicted crime.

a. True

There are many group health plan options available from paying 100 percent of annual premium costs to sharing a percentage of the annual insurance costs with employees.

a. True

An X in the Yes box of Block 20 indicates that:

a. an outside lab was used

Which type of insurance is considered risky yet is marketed to small business owners as a way to provide coverage to employees?

a. association health insurance

Block 14 of the CMS-1500 claim requires entry of the date the patient first experienced signs or symptoms of an illness or injury (or the date of last menstrual period for obstetric visits). Upon completion of Jean Mandel's claim, you notice that there is no documentation of that date in the record. The provider does document that her pain began five days ago. Today is May 10, YYYY. What do you enter in Block 14?

b. 05 05 YYYY

What kind of claim is used for billing provider fee-for-service claims to commercial health insurance companies?

b. CMS-1500

Disability insurance coverage may be paid even if an individual doesn't have disability insurance coverage.

b. False

Group health insurance covers all employees and their families regardless of health status; however, it can be cancelled if an employee becomes ill.

b. False

The birthday rule for a child covered by two or more insurance plans states that the oldest of the two policyholders shall be the primary policy holder for the child if they each have different insurance plans.

b. False

The correct format for birth date entry on the CMS-1500 claim is:

b. MM DD YYYY

When the CMS-1500 claim requires spaces in the data entry of a date, the entry looks like which of the following?

b. MM DD YYYY

When the CMS-1500 claim requires a response to YES or NO entries, enter

b. an X

Entering SIGNATURE ON FILE in block 12 of the CMS-1500 claim means that, in order to release medical information to the payer, the patient has signed a(n):

b. authorization.

An automobile insurance policy typically includes:

b. collision, comprehensive, liability, personal injury protection

Which involves securing a debtor's property as security or payment for a debt?

b. lien

When Block 25 of the CMS-1500 contains the provider's EIN, enter ________ after the first two digits of the EIN.

b. no punctuation or space

Block 24A of the CMS-1500 claim contains dates of service (FROM and TO). If a procedure was performed on May 10, YYYY, in the office, what is entered in the TO block?

b. nothing; leave the block blank

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

b. supplemental

Blocks 24A-24J of the CMS-1500 contain shaded rows, which can contain

b. supplemental information, per payer instructions.

When completing a CMS-1500 claim using computer software, text should be entered in ________ case.

b. upper

Often a commercial payer will implement changes to claims completion requirements throughout the year and most providers discover these changes

b. when claims are denied.

When a child who is covered by two or more plans lives with his married parents, the primary policyholder is the parent

b. whose birthday occurs first in the year.

The patient's name should be entered into Block 2 as:

c. ANTHONY, SUSAN, B

When SIGNATURE ON FILE is the appropriate entry for a CMS-1500 claim block, which is also acceptable as an entry?

c. SOF

When the same patient is covered by two plans (a primary payer plan and a secondary payer plan):

c. a primary claim is submitted to the primary payer and a new claim is generated and submitted to the secondary payer

When entering the patient's name in Block 2 of the CMS-1500 claim, separate the last name, first name, and middle initial (if known) with

c. commas

A traditional health insurance that covers a portion of services, such as inpatient hospitalizations, or physician office visits, with the patient paying the remaining costs.

c. fee-for-service

Diagnosis reference numbers are entered on the CMS-1500 claim to:

c. justify medical necessity

Which insurance covers losses to a third party caused by the insured, by an object owned by the insured, or on premises owned by the insured.

c. liability

When a patient is covered by the same primary and secondary commercial health insurance plan,

c. submit just one CMS-1500 to the payer.

________ is a policy that covers losses to a third party caused by the insured.

d. Liability insurance

An X in Block 8 of the CMS-1500 claims means that

d. None of the above, Block 8 should be left blank.

Insurance offered to members of a professional association and marketed to small business owners as a way to provide coverage to employees

d. association health insurance

When an insurance company uses the patient's social security number as the patient's insurance identification number, Block 1a of the CMS-1500 claim

d. contains the identification number without hyphens or spaces.

Which insurance is defined as reimbursement for income lost as a result of a temporary or permanent illness or injury?

d. disability

Commercial individual health insurance policies are regulated by individual states and include the following:

d. indemnity insurance, high-risk pools, managed care, association health insurance