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Insurance
MCO's
CMS-1500
CMS-1500 II
Misc
100
Name the 2 categories that the 4 types of health insurance fall into.
What is indemnity and managed care
100
Type of HMO where services are provided by outpatient networks composed of individual healthcare providers who supply all the patient care.
What is IPA
100
The bottom half of the CMS-1500 contains what information?
What is the physician/supplier information
100
The main reason that the CMS-1500 form was revised is to comply with the mandated NPI's under which act?
What is HIPAA.
100
Claims that are submitted with no errors and omissions are called ________ claims.
What is clean
200
Fee-for-service policies set a limit for what they will reimburse their members for any chargers incurred while under the policy, this is known as.
What is lifetime insurance cap
200
Enrollees typically pay an upfront cost when visiting the physician, this is called what.
What is co-payment
200
The front side of the CMS-1500 is printed in _________ and contains __________ individual blocks?
What is OCR scannable red ink and 33 individual blocks.
200
In block 3 of the CMS-1500 when reporting a birth date, how should it be reported?
What is MM DD YYYY
200
If an office is unable to submit a Medicare claim electronically, they can request a _________ from the HHS secretary.
What is waiver.
300
What type of insurance plans require the policy holder to pay premiums, meet a yearly deductible, and pay co-insurance.
What is Fee-for-service
300
Members of PPO can self direct and normally do not have to chose a __________?
What is Primary Care Provider
300
The patient information is entered into the CMS-1500 on which portion of the form?
What is the top
300
The 3 documents needed to complete the CMS-1500 are:
What is patient's health record, information form, and insurance card.
300
Direct data entry is when insurance claims submit directly to _______.
What is a third party payer
400
What is the system that is designed to determine if medical services were medically necessary.
What is utilization review.
400
Individuals that are members of managed care plans are commonly referred as:
What is enrollees
400
Which organization created the revised CMS-1500 dated 0805?
What is NUCC/NUBC
400
Information in blocks 1-13 is considered the _______ section.
What is patient/insured section
400
The preprinted customized form that is specific to a practice that lists all procedures and diagnosis are called what
What is encounter form/superbill
500
When an employer is resoponsible for paying the cost of all medical services, this is referred to as;
What is self-insurance
500
To reduce unnecessary cost of services, managed care plans use what?
What is utilization review
500
The OCR works best with original copies using Courier font and _______ fonts?
What is mono-spaced.
500
On the CMS-1500 the 9-digit federal tax identification number is known as:
What is Employer Identification Number
500
Timely filing is considered by BCBS and Medicare as how many days from date of service?
What is 365 days