1
The CMS-1500 claim form has an assignment of benefits for government programs in which field?
17-3
Field 12
17-3
The four main stages in the life cycle of an insurance claim are:
17-2
verifying insurance eligibility, coding procedures and diagnoses, transmitting the insurance claim, receiving the explanation of benefit and payment.
The reason that the CMS-1500 claim form is printed in red ink is:
17-3
to comply with OCR machines
Standards for electronic transmission of protected patient information, developed by the Health Insurance Portability and Accountability Act, is called the:
17-3
Transaction Code Set.
What Week are we in within our course?
11
The physician’s signatures on an electronic agreement or paper insurance claim are accepted in which of the following format?
17-3
First and last name, with credential.
A unique health identifier for health care providers is called a/an:
17-3a
NPI
A code that represents the physician’s Internal Revenue service employer identification number is called the:
17-3A
EIN
The format used to transmit electronic insurance claims was developed by the:
17-4b
ANSI
April 2
Medicare Part B claims are submitted to:
17-4c
MACs
An Advance Beneficiary Notice:
17-4c
must be completed when it is suspected that Medicare may not deem a service or supply medically necessary.
Timely filing rules for Medicare claims state that claims must be submitted:
17-4c
1 year from the date of service.
State disability claims are filed using:
17-4i
individual state forms
How many weeks total is this course?
15
Physicians accept payment from workers’ compensation insurance carriers:
17-4j
as payment in full.
A suspended claim is a:
17-5
claim held by the insurance company as pending because of an error or the need for additional information.
A dirty claim is a claim that:
17-5
is submitted with errors or one that requires manual processing.
Paid paper claims are filed according to:
17-5b
dates of service.
What are some ways to improve your grade?
Complete old discussions, turn in late homework, due extra credit.
The Medicare CERT program is used to:
17-5b
audit claims to determine if claim submission and payment are correct
A Medicare RAC auditor may go back _____________ and examine claims from the date of original determination.
17-5b
3 years
Which of the following is considered fraud and abuse under the False Claims Act?
17-5c
Billing separately for bundled services
What percent does an appeal have of being overturned?
175-d
50%
Have you registered for next semester courses yet?
Yes (I hope so!)