Who's Who
Which person is responsible for paying the charges?
Who is the guarantor
This form is submitted to the payer requesting reimbursement
What is the health insurance claim (CMS-1500)
On the CMS-1500 claim form, what NPI goes in Box 32a
Who is the facility or place of service (POS)
What is the clause that states a patient is not responsible for paying what the insurance plan denies
What is the hold harmless clause
Diagnosis pointer letters A-L are preprinted in Block 21 of the CMS-1500 claim to allow for entry of _____ codes, and they are reported in Block 24E
What is ICD-10-CM
Which of the following is considered a nonphysician practitioner?
1. Pharmacist
2. Physician Assistant
3. Provider
4. Nurse
What is a physician assistant (PA)
Medicare requires providers to submit the _______ claim for payment of outpatient and office services
What is CMS-1500
What is the format of an EIN number
00-0000000
(Nine digits total)
A lifetime maximum amount is the maximum benefits payable to a ___________
What is the health plan participant (subscriber/beneficiary/insured)
Which coding system is used to report procedures and services on claims
What is CPT (Current Procedural Terminology)
The Centers for Medicare and Medicaid Services (CMS) agency is located in the ________
What is DHHS (Department of Health & Human Services)
A claims attachment is _______ documentation associated with a health care claim or patient encounter.
What is supporting documentation
On the CMS-1500 claim form, what NPI goes in Box 33a
Who is the billing provider
This can be a group or individual - it all depends on how they are set up as a business.
Which is the amount for which the patient is financially responsible before an insurance policy provides payment
What is the deductible
CPT includes a section called Evaluation and Management (E/M) which describes patient encounters with providers for the purpose of the evaluation and management of ________________
What is general health status
Which was developed by the Centers for Medicare and Medicaid Services to assign the unique health care provider and health plan identifies and to serve as a database from which to extract data?
1. DOD OIG
2. HIPAA
3. ICD-10-CM
4. NPPES
What is NPPES (National Plan and Provider Enumeration System)
Which involves linking every procedure or service code reported on the claim to a condition/diagnosis code that justifies the necessity of performing that procedure or service
What is medical necessity
Block 33 of the CMS-1500 claim requires entry of the name, address, and telephone number of the ____________
(Billing entity)
A child is listed as a dependent on both his father's and his mothes group insurance poicies. The father's birth date is March 20, 1977, and the mother's birth date is March 6, 1979. Which policy is primary?
Who is the mother's policy (Birthday Rule)
The National Correct Coding Initiative (NCCI) was created to promote national correct coding methodologies and to eliminate __________ coding.
What is improper coding
Which act governs privacy, security, and electronic transactions standards for health care information and was implemented to provide better access to health insurance, limit fraud and abuse, and reduce administrative costs
What is HIPAA (Health Insurance Portability Act)
Patients sign Block 13 of the CMS-1500 claim to instruct the payer to directly reimburse the provider. This concept is called ____________.
What is "assignment of benefits"
On the CMS-1500 claim form, what NPI goes in Box 17a
Who is the referring
When the "YES" box in Block 27 of the CMS-1500 claims contains an "X" the provider agrees to receive payment in full whatever the payer reimburses. This concept is called __________
What is "accept assignment"
Which part of the SOAP notes contains the chief complaint and the patient's description of the presenting problem?
What is Subjective
(Subjective, Objective, Assessment, Plan)