Chapter 12 Quick Check mindtap

an outside lab was used

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

collision, comprehensive, liability, and personal injury protection

An automobile insurance policy typically includes:

05 05 YYYY

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?

05 10 YY

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?

NPI

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

supplemental information, per payer instructions

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

indemnity insurance, high-risk pools, managed care, and association health insurance

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

supplemental

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

justify medical necessity

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

authorization

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):

$115

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.

12 months and is divided into four consecutive quarters

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

a child covered by two or more plans

The birthday rule is used to determine the primary insurance policy when the patient is:

MM DD YYYY

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

ANTHONY, SUSAN, B

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

assignment of benefits

The process whereby the patient allows the payer to directly reimburse the provider is called:

CMS-1500

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

no punctuation or space

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

SOF

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

whose birthday occurs first in the year

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

EGHP

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

submit just one CMS-1500 to the payer.

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

contains the identification number without hyphens or spaces.

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

upper

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

commas

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

an X

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

MM DD YYYY or MM DD YY

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

liability

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?

disability

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

lien

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

subrogation

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

association health insurance

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

automobile insurance policy

contract between an individual and an insurance company whereby the individual pays a premium and, in exchange, the insurance company agrees to pay for specific car-related financial losses during the term of the policy; typically includes medical-payments coverage and personal injury protection (PIP) to reimburse health care expenses sustained as the result of injury from an automobile accident.

commercial health insurance

covers the medical expenses of individuals groups; premiums and benefits vary according to the type of plan offered.

Which is entered in Block 11c of the CMS-1500?

name of commercial health insurance plan

liability insurance

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

subrogation

process of the third-party payer recovering health care expenses from the liable party.

disability insurance

reimbursement for income lost as a result of a temporary or permanent illness or injury

indemnity insurance

.compensates policyholders for actual economic losses, up to limiting amounts on insurance policy, and it usually requires the insured to prove losses before payment is made (e.g., automobile insurance).

base period

.period of time that usually covers 12 months and is divided into four consecutive quarters.

lien

.pledges or secures a debtor's property as security or payment for a debt; may be used in a potential liability case, but use varies on a federal and state basis.

when claims are denied

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

When a patient is covered by a primary payer plan and a different secondary payer plan:

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