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CMS-1500
NHA EXAM
| Question | Answer |
|---|---|
| CMS-1500 has ______ Sections | Two Section Section 1: Patient & Insured Information Section 2: Physician or Supplier Information |
| Block 9B | Other Insured's DOB & Gender Inf. |
| Block 11D | Leave Blank |
| Block 12 | Patient’s or Authorized Person’s Signature Authorizing any medical or other information necessary to process a claim. |
| Section 1 | Blocks 1- 13 |
| Section 2 | Blocks 14 - 33 |
| Block 24 B | Place of Service (POS) Location where services billed on this claim were performed. Valid values: National POS codes maintained by CMS. |
| Block 24 D | Procedures, Services, or Supplies CPT or HCPCS (5-position) code describing the procedures performed, medical services rendered or the supplies furnished. |
| Block 26 | Enter the patients account number as assigned by the provider or supplier |
| Block 28 | Enter the total charge of all services |
| _____ initials to remember in Block 17 | 3 Initials |
| Blocks 1- 8 focus on what kind of information? | Personal & Main Insurance Information |
| Blocks 9 - 11 focus on what kind of information? | Any other Insurance Information, Any Employer's Information & Any Condition Related / Pertaining to claim Purposes |
| What are the three main blocks that require a signature? | Block 12: Patient or Authorized Person's Signature Block 13: Insured or Authorized Person's Signature Block 31: Signature of Physician or Supplier |
| Blocks 21 & 24 Focus on what kind of information? | 21: Diagnosis/Diagnosis Codes (4 total) or Illness related to claim 24: DOS, POS, EMG, Procedures, Services or Supplies |
| Block 24 D includes what kind of Codes? | CPT/HCPCS and any Modifiers |
| Block 23 Focuses on what kind of information? | Individual / Main Charges Total of charges Any Amount(s) paid & Amount(s) due |
| What are the four main blocks that require an NPI number? | Block 17 B Block 32 A Block 23J Block 33 A |
| Blocks 16 & 18 Focus on what kind of information? | Any Dates unable to work Any Dates of Hospitalization |
| How many Blocks on the CMS are left blank? | There are 8 blocks left blank |
| How many blocks in the first section of the form left blank? | There are 3 blocks that are left blank in this section: Block 8 Block 9B Block 11 D |
| How many blocks in the Second section of the form left blank? | There are 4 blocks that are left blank in this section: Block 15 - Only used if provider is seeing patient in a facility Block 22 Block 24 H Block 30 |
| How many insurance selections are there to choose from in the first section of the form in block 1? | There are 7 blocks: Medicare Medicaid TRICARE Champus & ChampVA Group. Health Ins FECA & Other |
Created by:
SBright