Parts of CMS-1500
Section 1 is what information?
Carrier, type of information
A set dollar amount that the policyholder must pay before the insurance company starts to pay for services
What is the deductible
What is the statement from an insurance company describing the amount paid, denied, and applied to a person’s deductible?
What is the explanation of benefit
What information goes into block 11 of a CMS claim form?
what is the insurance group number
___ is the management of debt incurred and not yet paid.
What is accounts payable
Section 2 is what information
Patient/insured's information
Policyholder responsibility after deductible has been met
What is coinsurance
The process of obtaining a dollar amount approved for a medical procedure or service that is to be scheduled is
what is precertification
When filling a CMS 1500, what number represents the Place of Service Code for doctors’ office visits?
What is 11
It is considered an offer of credit when the healthcare facility allows the patient to make more than _______ payments on his or her balance.
What is 4
Section 3 is what information?
what is Physician/Facility information
A fixed amount the patient pays for a covered service after the deductible is met
What is a copay
A clearinghouse is a healthcare entity that acts as an intermediary between the healthcare facility and the
What is the insurance company
A claim that has been denied for any reason, including a preexisting condition, is called a ________________ claim.
what is rejected claim
What document must be provided to the patient if the healthcare facility and patient agree that payment will be made in more than four installments?
What is the Truth in Lending Statement
What 2 codes are required on the CMS-1500?
What are the ICD-10 & CPT codes
The amount that insurance dictates the PAR provider can charge for a specific service.
What is the allowed amount
Who is responsible for the entire medical bill?
Who is the guarantor
A claim that has been denied for inaccurate information is called a ____________ claim.
what is a dirty claim
What type of endorsement usually includes the words “without recourse?”
What is a qualified endorsement
A code issued by an insurance company for a service that is proven to be medically necessary, must be present on claim form in box 23
What is preauthorization
The truth in lending statement must be provided with the minimum of _ payments?
What is 5
Who pays allowable charges, or the maximum amount of money paid for a service?
Who is the third party payer
When filling a CMS 1500, what is the Place of Service Code for an emergency room visit?
What is 23
The amount someone is paid after taxes and other deductions have been subtracted is called
What is net pay