Insurance & Billing: Medical Claims

Insurance & Billing: Medical Claims

Multiple Choice

What is the purpose of an insurance claim?

• It gives the patient a record of insurance pay-outs

• It gives the physician a record of the patient visit

• It allows the patient to sue the insurance carrier

• It allows physicians and insurance carriers to communicate

Multiple Choice

What is the name of the currently accepted Universal Claim Form for the medical office?

• CMS 1500 (08-05)

• HCFA 1500

• Uniform Bill 92

• CMS 1500 (02-12)

Multiple Choice

What claim form is used for inpatient hospital services?

• Uniform Bill 04

• CMS 1500 (02-12)

• HCFA 1500

• CMS 1500 (08-05)

Multiple Choice

Incomplete insurance claims will not be processed

• True

• False

Multiple Choice

Why might the procedure on a claim be downcoded?

• Because the diagnosis it indicates no longer exists.

• Because the OCR scanner could not read the code.

• Because the patient's deductible has not been met.

• Because the code was unclear or outdated.

Multiple Choice

Why must a patient authorize the release of medical information to the insurance carrier?

• To speed up processing time.

• To protect the physician's privacy.

• To allow private information to be shared.

• To allow the office to sell personal data.

Multiple Choice

On a claim form, what does SOF stand for?

• Service Order Form

• Signed on Faith

• Signature on File

• Soldier of Fortune

Multiple Choice

In which section of the claim form should the patient and insured information be placed?

• Blocks 14-33

• Blocks 1-13

• The back of the claim form