FORMS
LET'S MAKE A DATE
EMERGENCY PREPAREDNESS
CMS GUIDELINES
NAME THAT CLAIM
100

Misusing codes on a Medicare claim form is an example of this

What is ABUSE

100

A CMS - 1500 form uses this format for date of birth of the patient 

What is MM  DD  YYYY

100

This plan must include how the medical office will manage medical waste

What is EXPOSURE CONTROL PLAN

100

Making false statements that either directly or indirectly result in unnecessary costs to Medicare

What is ABUSE

100

The main claim form used for Medicare

What is a CMS-1500 form

200

A CMS - 1500 form is used to submit electronic claims for MEDICARE, True or False

What is False.  CMS - 1500 is used to submit PAPER claims for Medicare.

200

An Incident Report (OSHA Form 301) is completed within _______ calendar days after notification

What is seven (7)

200

The MSDS stands for

What is Material Safety Data Sheet

200

What follows primary insurance when the patient has two (2) insurance plans

What is secondary insurance

200

Assigning a diagnosis or procedure code at a higher level than documentation supports

What is UPCODING

300

This form is completed even if no work-related illness or injuries occur

What is OSHA form 300A or Summary of Work-Related Injuries and Illnesses
300
These two OSHA forms are kept on file for a minimum of five (5) years
OSHA Form 300 (Log) and OSHA Form 300A (Summary)
300

Companies that destroy or remove medical waste must give one of these to the medical office

What is a receipt

300

The Healthcare Integrity and Protection Data Bank (HIPDB) compiles information about these two things

What are FRAUD and ABUSE

300

Using multiple codes instead of a single code to charge excessively for services

What is UNBUNDLING

400

What is the form number AND name of the log that employers must complete for OSHA to report workplace injuries

What is OSHA form 300 Log of Work-Related Injuries and Illnesses

400

OSHA'S Final Rule on Bloodborne Pathogens was effective in this year

What is 1992

400

A Safety Officer has given the order to evacuate.  These individuals should leave first

What are the people nearest the danger

400

The documented need for a particular medical intervention is known as this

What is MEDICAL NECESSITY

400

Making a false statement for the purposes of receiving payments is known as 

What is FRAUD

500

Any narrative involving an injury should include a signature as reviewed by a

What is a supervisor

500

Mr. Jones was born in 1963 but has a recent disability.  This makes him eligible for this program

What is Medicare

500

3 things that are part of every Emergency Preparedness Plan

What are: 1. How to inform patients, employees about an emergency

2. How to evacuate

3. Who should be left behind to monitor critical equipment before evacuating.

500

Healthcare fraud and abuse falls under this comprehensive program

What is HCFAP (Health Care Fraud and Abuse Program)

500

Also called a CMS-1450 claim form

What is a UB-04 form