Question 1

Three entities covered by HIPAA are:

Accepted Answer

Health plans,
Health care clearinghouses,
Health care providers

Question 2

Identical procedures or services can be reported on the same line if two of the following four circumstances apply:

Accepted Answer

Procedure performed on consecutive days in the same month,
Same code assigned to procedure/service reported,
Identical charges apply to assigned code,
Block 24G (days or units) is completed

Question 3

When a doctor refers a patient to the hospital for observation and bypasses the clinic or E.R. this is called...

Accepted Answer

Direct Admission

Question 4

A combined medical/surgical case is

Accepted Answer

when someone is admitted as a medical case but after testing, they require surgery

Question 5

Secondary claims are processed

Accepted Answer

AFTER the R.A. is generated on the first claim.

Question 6

Claims with no processing errors and payments in full are marked "closed" and moved to the

Accepted Answer

closed assigned claims file

Question 7

HIPAA privacy standards require providers to

Accepted Answer

NOTIFY patients about their right to privacy

Question 8

The Medicare Conditions of Participation (CoP) requires a provider to keep copies of

Accepted Answer

government insurance CLAIMS  and copies of  ALL ATTACHMENTS filed by the provider.

Question 9

Observation services are reimbursed under the Outpatient Prospective Payment System using the

Accepted Answer

UB-04 as an alternative to inpatient admission

Question 10

Supplemental plans usually cover the

Accepted Answer

DEDUCTIBLE and COPAY OR COINSURANCE  of a primary health insurance policy

Question 11

The surgeon's charges for inpatient and outpatient surgery are billed according to a

Accepted Answer

GLOBAL SURGICAL PACKAGE

Question 12

Typewritten and handwritten claims have

Accepted Answer

HIGHER errors rates

Question 13

The legal business name of a practice is its

Accepted Answer

BILLING ENTITY

Question 14

To report more than

Accepted Answer

SIX procedures or services for the same date of service, it is necessary to generate a new claim form.

Question 15

Chronic conditions, such as diabetes mellitus or hypertension, always require medical management, therefore should

Accepted Answer

ALWAYS be reported on the claim form

Question 16

It is important to

Accepted Answer

NOT  enter commas, periods, or other punctuation in the address on a claim form.

Question 17

The first-listed code reported is the

Accepted Answer

MAJOR reason the patient was treated by the health care provider

Question 18

Block 13

Accepted Answer

of the CMS-1500 claim authorizes payment of medical benefits to physicians or suppliers

Question 19

The National Provider Identifier (NPI) is a unique

Accepted Answer

10-digit number issued to individual providers and heatlh care organizations

Question 20

Only FOUR

Accepted Answer

diagnosis codes can be listed on a single claim

Question 21

BACKEND RECOVERY

Accepted Answer

refers to a vendor who specializes in pursuing funds from the appropriate payer

Question 22

The development of an insurance claim begins when the patient

Accepted Answer

contacts the health care provider's office for an appointment

Question 23

Optical scanning of paper claims uses a scanner to convert printed or handwritten characters into text that can be viewed by an

Accepted Answer

OPTICAL CHARACTER READER

Question 24

Provider services for inpatient care are billed on a

Accepted Answer

fee-for-service basis

Question 25

A claims attachment should be sued when:

Accepted Answer

A patient's stay in the hospital is prolonged, 
An outpatient/office procedure is performed as an inpatient,
A procedure is submitted with an unlisted procedure code

Question 26

Medicare coverage for observation services is limited to no more than

Accepted Answer

48 hours

Question 27

To improve the accuracy of Medicare payments by detecting and denying unlikely Medicare claims on a prepayment basis CMS implemented,

Accepted Answer

Medically Unlikely Edits project

Question 28

When entering the patient's name in Block 2, separate the last name, first name, and middle name with

Accepted Answer

commas

Question 29

Never code diagnoses that begin with the words

Accepted Answer

"probable", "suspicious for" , or "rule out"

Question 30

A non-physician practitioner provides services to patients under direct supervision of a physician. The billing is considered

Accepted Answer

"incident to"

Question 31

In Block 21 of the CMS-1500 claim, a maximum of

Accepted Answer

FOUR ICD-9-CM codes may be entered

Question 32

By May 2008, submission of ht NPI was required on the CMS-1500 claim for:

Accepted Answer

Large health plans,
Health care clearinghouses,
Small health plans

Question 33

Patients sign Block 13 of CMS-1500 form to instruct the payer to directly reimburse the provide; this is an

Accepted Answer

ASSIGNMENT OF BENEFITS

Question 34

The Federal Privacy Act of 1974

Accepted Answer

prohibits a payer from notifying the provider about payment or rejection of unassigned claims or payments sent directly to the patient/policyholder

Question 35

Medical management

Accepted Answer

deals with chronic conditions affecting patient care

Question 36

National Provider Identifier (NPI)

Accepted Answer

is a ten digit number issued to providers

Question 37

Under "assignment of benefits",

Accepted Answer

the payer directly reimburses the provider

Question 38

A claim attachment is required when an

Accepted Answer

UNLISTED CODE is used

Question 39

Accept Assignment

Accepted Answer

means that the provider accepts payment in full form the payer

Question 40

Units of Service

Accepted Answer

number of encounters

Chapter 11

review

Question	Answer
Three entities covered by HIPAA are:	Health plans, Health care clearinghouses, Health care providers
Identical procedures or services can be reported on the same line if two of the following four circumstances apply:	Procedure performed on consecutive days in the same month, Same code assigned to procedure/service reported, Identical charges apply to assigned code, Block 24G (days or units) is completed
When a doctor refers a patient to the hospital for observation and bypasses the clinic or E.R. this is called...	Direct Admission
A combined medical/surgical case is	when someone is admitted as a medical case but after testing, they require surgery
Secondary claims are processed	AFTER the R.A. is generated on the first claim.
Claims with no processing errors and payments in full are marked "closed" and moved to the	closed assigned claims file
HIPAA privacy standards require providers to	NOTIFY patients about their right to privacy
The Medicare Conditions of Participation (CoP) requires a provider to keep copies of	government insurance CLAIMS and copies of ALL ATTACHMENTS filed by the provider.
Observation services are reimbursed under the Outpatient Prospective Payment System using the	UB-04 as an alternative to inpatient admission
Supplemental plans usually cover the	DEDUCTIBLE and COPAY OR COINSURANCE of a primary health insurance policy
The surgeon's charges for inpatient and outpatient surgery are billed according to a	GLOBAL SURGICAL PACKAGE
Typewritten and handwritten claims have	HIGHER errors rates
The legal business name of a practice is its	BILLING ENTITY
To report more than	SIX procedures or services for the same date of service, it is necessary to generate a new claim form.
Chronic conditions, such as diabetes mellitus or hypertension, always require medical management, therefore should	ALWAYS be reported on the claim form
It is important to	NOT enter commas, periods, or other punctuation in the address on a claim form.
The first-listed code reported is the	MAJOR reason the patient was treated by the health care provider
Block 13	of the CMS-1500 claim authorizes payment of medical benefits to physicians or suppliers
The National Provider Identifier (NPI) is a unique	10-digit number issued to individual providers and heatlh care organizations
Only FOUR	diagnosis codes can be listed on a single claim
BACKEND RECOVERY	refers to a vendor who specializes in pursuing funds from the appropriate payer
The development of an insurance claim begins when the patient	contacts the health care provider's office for an appointment
Optical scanning of paper claims uses a scanner to convert printed or handwritten characters into text that can be viewed by an	OPTICAL CHARACTER READER
Provider services for inpatient care are billed on a	fee-for-service basis
A claims attachment should be sued when:	A patient's stay in the hospital is prolonged, An outpatient/office procedure is performed as an inpatient, A procedure is submitted with an unlisted procedure code
Medicare coverage for observation services is limited to no more than	48 hours
To improve the accuracy of Medicare payments by detecting and denying unlikely Medicare claims on a prepayment basis CMS implemented,	Medically Unlikely Edits project
When entering the patient's name in Block 2, separate the last name, first name, and middle name with	commas
Never code diagnoses that begin with the words	"probable", "suspicious for" , or "rule out"
A non-physician practitioner provides services to patients under direct supervision of a physician. The billing is considered	"incident to"
In Block 21 of the CMS-1500 claim, a maximum of	FOUR ICD-9-CM codes may be entered
By May 2008, submission of ht NPI was required on the CMS-1500 claim for:	Large health plans, Health care clearinghouses, Small health plans
Patients sign Block 13 of CMS-1500 form to instruct the payer to directly reimburse the provide; this is an	ASSIGNMENT OF BENEFITS
The Federal Privacy Act of 1974	prohibits a payer from notifying the provider about payment or rejection of unassigned claims or payments sent directly to the patient/policyholder
Medical management	deals with chronic conditions affecting patient care
National Provider Identifier (NPI)	is a ten digit number issued to providers
Under "assignment of benefits",	the payer directly reimburses the provider
A claim attachment is required when an	UNLISTED CODE is used
Accept Assignment	means that the provider accepts payment in full form the payer
Units of Service	number of encounters

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