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Health Insurance

HI chps 11-13

What is commonly assigned to patients who present to the ED and who then require a significant period of treatment or monitoring before a decision is made concerning their admission or discharge? Observation status
What occurs when a physician in the community refers a patient to the hospital for observation, bypassing the clinic or ED? Direct admission
What is one charge that covers presurgical evaluation and management, initial and subsequent hospital visits, surgical procedure, the discharge visit, and uncomplicated postoperative follow-up care? Global fee or Global surgery package
Postoperative complications requiring a return to the operating room for surgery related to the original procedure are billed as an additional what? Procedure
How are birth dates entered on the CMS-1500 claim? As eight digits with spaces between the digits representing the month, day, and four-digit year.
How do you enter a provider on the CMS-1500 claim? First name, middle initial (if known), last name, and credentials. Do not enter any punctuation.
What is a unique 10-digit number issued to individual providers and healthcare organizations? National Provider Identifier
What is it called when the patient instructs the payer to directly reimburse the provider? Assignment of Benefits
What is it called when the provider agrees to accept as payment in full whatever the payer reimburses? Accept Assignment
How many ICD-9-CM codes may be entered on a single CMS-1500 claim? Four
What is the POS (Point of Service) code used for physician's offices? Eleven
How many procedures and/or services may be reported on a single CMS-1500 claim? Six
Which procedure/service code should be entered first on the CMS-1500 claim? The one with the highest fee.
What is the legal business name of a practice called? Billing entity
What are supplemental plans designed by the federal government that are sold by private commercial insurance companies to "cover the gaps in Medicare"? Medigap
When a child who is covered by two or more plans lives with his married parents, the primary policyholder is who? The parent whose birthday occurs first in the year.
What type of text should be used to enter the data onto a CMS-1500 claim? Upper case
What is an employer-sponsored health benefits program that was established by an Act of Congress in 1959? FEHBP or FEP (Federal Employee Program)
What is the amount commonly charged for a particular medical service by providers within a particular geographic region for establishing the allowable rates? Usual, customary, and reasonable (UCR)
What is an acceptable abbreviation for SIGNATURE ON FILE for box 12 on the CMS-1500 claim? SOF
Created by: YTIMBC
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