Chapter 12 Review and Assign Questions
Logan is the daughter of Amy (DOB 3/29/68) and Bill (BOD 11/15/70) and is covered by both parents' health insurance plans. According to the birthday rule, a medical claim for Logan will be submitted to
Amy's plan as primary payer and Bill's plan as secondary payer.
Beatrice Blue holds a private commercial health care policy, and she wishes to have payment from health insurance company sent directly to her provider. How is this reported on the CMS-1500?
Beatrice Blue will sign Block 13.
When laboratory tests are performed in the office, enter an X in the NO box of
Block 20.
The patient was required to obtain an authorization number before being treated by a specialist. Where is the authorization number entered in the CMS-1500 claim?
Block 23
When a patient is covered by a large employer group health plan (EGHP) and Medicare, which is primary?
EGHP
When a patient is covered by a large employer group health plan (EGHP), and the patient is also a Medicare beneficiary, ________ is primary.
EGHP
A balance of $12.55 is due to the patient for services provided by Dr. Brown. What is entered in Block 30 of the CMS-1500 claim?
Leave blank
When the CMS-1500 claim requires spaces in the data entry of a date, the entry looks like which of the following?
MM DD YYYY or MM DD YY
Dr. Smith evaluates Marcia Brady during a three-month recheck of her diabetes mellitus. He performs venipunture and sends the patient's blood sample to an outside laboratory for testing of the blood glucose level. Dr. Smith's insurance specialist enters the outside laboratory's _______ in Block 24J because the blood glucose test is reported in Block 24D on the line.
NPI
Block 33a of the CMS-1500 claim contains the provider's
NPI.
Which is considered a commercial health insurance company?
Prudential
When SIGNATURE ON FILE is the appropriate entry for a CMS-1500 claim block, which is also acceptable as an entry?
SOF
When entering the patient's name in Block 2 of the CMS-1500 claim, separate the last name, first name, middle initial (if known) with
commas.
Reimbursement for loss of or damage to a vehicle (e.g. caused by fire, flood, hail, theft, vandalism, or wind) is covered by _______ (automobile) insurance.
comprehensive
When an insurance company uses the patient's SSN as the patient's insurance identification number, Block 1a of the CMS-1500
contains the identification number without hyphens or spaces.
Reimbursement for income lost as a result of a temporary or permanent illness or injury is covered by ________ insurance.
disability
Which health plan is required to accept employees and their family members?
group
Which claims are submitted to cover the cost of medicare for traumatic injures, lost wages, pain, and suffering?
liability
When an insurance claim is submitted to an insurance company that covers the treatment of injured sustained in a motor vehicle accident, the _________ reviews the claim and determines coverage for the injured person.
medical adjuster
When an insurance claim is submitted to an insurance company that covers the treatment of injuries sustained in a motor vehicle accident, the ______ reviews the claim and determines coverage for the injured person.
medical adjuster
What is entered in Block 24J if the provider is a member of a group practice?
national provider identifier (NPI)
What is entered in Block17b of the CMS-1500 claim?
national provider identifier (NPI)
Another term that can be used to indicate a fee-of-service plan is a ______ plan.
noncapitated
When the same commercial payer issues the primary and secondary or supplemental policies, it is generally acceptable to submit ______ claim(s).
one
When the patient is the domestic partner of the primary policyholder, this is indicated on the CMS-1500 claim by
placing an X in the OTHER box of Block 6.
When the patient is the domestic partner of the primary policyholder, this is indicated on the CMS-1500 claim form by......
placing an X in the OTHER box of block 6
A secondary health insurance plan generally provides coverage that is ........
similar to that of a primary health insurance plan.
When a patient is covered by the same primary and secondary commercial health insurance plan,
submit just one CMS-1500 to the payer.
Blocks 24A-24J of the CMS-1500 contain shaded rows, which can contain
supplemental information, per payer instructions.
When completing a CMS-1500 claim using computer software, text should be entered in ______ case.
upper
When a child who is covered by two or more plans lives with his married parents, the primary policyholder is the parent
whose birthday occurs first in the year.
Nancy White's employer provides individual and family group health plan coverage, and it pays 80% 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.
$115
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 of 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 05 YYYY
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?
05 10 YY
The patient was seen in the provider's office on 12/03/YYYY for an injury sustained four months earlier. What is entered in Block 14 of the CMS-1500 claim?
08 03 YYYY
What is the correct way to enter the provider's name and credential in Block 31?
JOHN BROWN MD
If the patient has paid a copayment on the claim being submitted, this is indicated on the CMS-1500 claim by entering the
amount paid in Block 29.
When the CMS-1500 claim require a response to YES or NO entries, enter
an X
