MBC B&I Ch 14 & Ch 15

Effective October 16, 2003, ASCA required

• all claims sent to Medicaid be submitted electronically.

• all claims sent to Medicare be submitted electronically.

• all claims sent to Blue Shield plans be submitted electronically.

• All are correct.

When completing a CMS-1500 claim form, if any question is unanswerable

• leave the space blank.

• use DNA (does not apply).

• use N/A (not applicable).

• use NA (not applicable).

The appropriate method for entering the date of service (January 4, 2xxx) on a CMS-1500 claim form is

• 1/4/xx.

• 01042xxx.

• 01-04-xx.

• 01 04 xx.

Office visits may be grouped on the insurance claim form if each visit

• is consecutive and uses the same procedure code.

• is consecutive, uses the same procedure code, and results in the same fee.

• uses the same diagnosis code.

• occurs during the same month.

The number issued to physicians by the Internal Revenue Service for income tax purposes is known as

• TIN.

• PIN.

• UPIN.

• NPI.

Which of the following is a lifetime 10-digit number issued to physicians that replace all other numbers assigned by various health plans?

• TIN

• PIN

• UPIN

• NPI

If a CMS-1500 claim is denied by the insurance company because the medical service/procedure was performed during a global surgical period, the insurance billing specialist should:

• write-off the billed amount

• automatically resubmit the claim

• change the date of the medical service/procedure

• resubmit the claim with the appropriate modifier to indicate the procedure is unrelated to the service that initiated the global surgical period

OCR guidelines for the CMS-1500 claim form state

• it can be photocopied by the physician’s office to save the expense of buying huge quantities.

• it can be submitted with handwritten information.

• it should not be photocopied because it cannot be scanned.

• enter all information in lowercase letters.

What is the block number of the CMS-1500 claim form used to report the insured’s policy, group or FECA number?

• Block 1

• Block 6

• Block 11

• Block 11b

When completing block 19 of the CMS-1500 claim form, what qualifier is used to indicate “Goals, Rehabilitation Potential or Discharge Plans”?

• ADD

• DCP

• DGN

• TPO