Medical Billing & Coding Ch.7
If a claim is to be submitted on paper and there are more services to be billed, what do you put in Item Number 28 of page one?
"Continued"
If there is no signature on file for the insured, which of the following can be entered in IN 13 of the CMS-1500 claim form? (Select all that apply.)
"No Signature on File" Leave blank
If the claim reports an encounter with no charge what value may be used?
0
Which field on the CMS-1500 claim form is most commonly used for multiple visits, units of supplies, anesthesia units or minutes, or oxygen volume?
24G
What Item Number works together with IN 24J to show the ID number for the rendering provider (the individual who is providing the service)?
24I
What Item Number on the CMS-1500 claim form lists the total of all charges in Item Number 24F, lines 1 through 6?
28
If the information in Item Number 33 is different from that in Item Number _____, enter the name, address, city, state, and nine-digit Zip code of the location where the services were rendered.
32
What Item Number on the CMS-1500 claim form identifies the provider that is requesting to be paid for the services rendered and should always be completed?
33
When resubmitting a claim, you must enter a bill frequency code aligned left in the left-hand side of the field. Which of the following would be correct bill frequency codes to place in Item Number 22? (Select all that apply.)
7 8
Which of the following is a correct claim code that would be entered in Item Number 10d of the CMS-1500 claim form?
BGAH
_____ codes are two-digit numeric or alphanumeric codes used to report a special condition or unique circumstance about a claim.
Condition
What refers to the number of days corresponding to the dates entered in 24A or units as defined in CPT or HCPCS?
Days or units
For IN 24E, what refers to the line number from IN 21 that provides the link between diagnosis and treatment?
Diagnosis pointer
When entering the numbers for the amount charged in IN 24F, which of the following should not be entered? (Select all that apply.)
Dollar signs Decimals Commas
What does EPSDT stand for?
Early and periodic screening, diagnosis, and treatment
What number is the nine-digit alphanumeric identifier assigned to a patient who is an employee of the federal government claiming work-related condition(s) under the Federal Employees' Compensation Act?
FECA
The date entered in Item Number 14 of the CMS-1500 claim form refers to which of the following dates about the patient? (Select all that apply.)
First date of onset of illness Actual date of injury LMP for pregnancy
If the patient has group contract insurance with a private payer, which type of insurance is selected in Item Number 1 of the CMS-1500 form?
Group Health Plan
The organization of the data elements on the _____ is efficient for electronic transmission rather than for use on a paper form.
HIPAA 837P Claim
Where do you enter the CPT or HCPCS code(s) and modifier(s) (if applicable) from the appropriate code set in effect on the date of service on the CMS-1500 claim form?
IN 24D
Where on the CMS-1500 claim form do you enter the billing provider's Employer Identification Number (EIN) or Social Security number?
IN 25
Where on the CMS-1500 claim form do you enter the patient's account number that is used by the practice's accounting system?
IN 26
When physicians are billing for purchased diagnostic tests or radiology services, they must identify the supplier's name, address, nine-digit Zip code, and NPI in which field of the CMS-1500 claim form?
IN 32a
When grouping services, which of the following must be identical for that service line? (Select all that apply.)
Individual provider Place of service Charges Procedure code
What Item Number of the CMS-1500 claim form must be marked yes if Item Numbers 9, 9a, and 9d are completed?
Item Number 11d
What Item Number of the CMS-1500 claim form indicates that the insured's or authorized person's signature is on file authorizing payment of medical benefits directly to the provider of the services listed on the claim?
Item Number 13
What Item Number on the CMS-1500 claim form is used to report additional claim information?
Item Number 19
Which Item Number is used to report outside lab charges to show that services have been rendered by an independent provider, as indicated in IN 32, and to list the related costs?
Item Number 20
What Item Number on the CMS-1500 claim form is used to report the date(s) of service and indicates the actual month, day, and year the service was provided?
Item Number 24a
If a husband is covered by his employer's group policy and by his wife's group health plan, where would you enter the wife's name on the CMS-1500 claim form?
Item Number 9
When a legal signature is used in IN 12 of the CMS-1500 claim form, which of the following formats are used when entering the date signed? (Select all that apply.)
MM/DD/YY MM/DD/YYYY
The Item Number for EPSDT Family Plan refers to some services that may be covered under state _____ plans.
Medicaid
What supplemental information can be entered in the shaded areas of IN 24?
NDCs for drugs Device Identifiers narrative description of unspecified codes
Match each place of service code to its definition.
Office 12 matches Choice, Home Home 21 matches Choice, Inpatient hospital Inpatient hospital 22 matches Choice, Outpatient hospital Outpatient hospital 23 matches Choice, Emergency room—hospital Emergency room—hospital 24 matches Choice, Ambulatory surgical center Ambulatory surgical center 31 matches Choice, Skilled nursing facility Skilled nursing facility 81 matches Choice, Independent laboratory Independent laboratory
When do you report the patient's information in Item Number 5 of the CMS-1500 claim form?
Only if it is different from the insured's information
Regarding the area indicating the sex (gender) of the insured in Item Number 11a of the CMS-1500 claim form? (Select all that apply.)
Only one box, either male or female, can be checked. No box is checked if the gender is unknown.
What kind of vendors are responsible for keeping their software products up to date?
PMP
What two-digit code is entered into Item Number 24b of the CMS-1500 claim form that describes the location where the service was provided?
POS
What information is used primarily to help identify patients and post payments when working with remittance advices?
Patient's account number used by the practice's accounting system
Like the CMS-1500, the HIPAA 837P claim requires data on which of the following types of providers? (Select all that apply.)
Referring provider Pay-to provider Billing provider Rendering provider
What information is entered into IN 24J on the CMS-1500 claim form?
Rendering provider ID
What term is used on the HIPAA 837P for the insurance policyholder or guarantor, meaning the same as the insured on the CMS-1500 claim?
Subscriber
What code is a ten-digit number that stands for a physician's medical specialty?
Taxonomy
Which of the following statements are true of Item Number 7: Insured's Address on the CMS-1500 form? (Select all that apply.)
The address of the person listed in IN 4 should be used. This field refers to the insured's permanent residence.
In Item Number 18 of the CMS-1500 claim form, how are the dates entered for patients still hospitalized?
The admission date is listed in the From box, and the To box is left blank.
In order to relate the date of service and the procedures to the primary diagnosis, what is entered into IN 24E on the CMS-1500 claim form?
The diagnosis code reference letter from IN 21
When billing HCPCS codes for products such as drugs, durable medical equipment, or supplies, the payer may require supplemental information using which of the following indicators and codes? (Select all that apply.)
VP indicator and Health Industry Business Communications Council (HIBCC) indicator OZ indicator and Global Trade Item Number Anesthesia duration N4 indicator and the National Drug Codes
What is the qualifier that is to be used when reporting services for narrative description of unspecified codes?
ZZ
A(n) _____ code is an administrative code used to identify the type of health plan, such as a PPO.
claim filing indicator
How many 2-character modifiers can be entered into Item 24D: Procedures, Services, or Supplies for each CPT/HCPCS code?
four
When completing Item Number 33 of the CMS-1500 claim form, it is important to note that no punctuation is used in the address, other than the _____ for the nine-digit Zip code, and no space or hyphen is used as a separator within the phone number or between the qualifier and non-NPI identifier.
hyphen
The _____, called the Other ID number, of the referring provider, ordering provider, or other source is the payer-assigned unique identifier of the physician or other healthcare provider.
non-NPI ID number
The _____ number refers to the payer-assigned number authorizing the service(s).
prior authorization
The _____ may affect the physician's pay, usually because of the payer's contract with the physician.
type of specialty
