CMS-1500 Form Quiz 10/31

What is the CMS-1500 form primarily used for?

• Filing hospital inpatient claims

• Submitting claims for physician and outpatient services

• Reporting medical diagnoses only

• Billing pharmacy services

What is the purpose of Field 1 on the CMS-1500 form?

• To list the patient’s name

• To indicate the type of insurance coverage

• To identify the provider’s NPI number

• To describe the services provided

What information is entered in Field 2 on the CMS-1500 form?

• Patient’s insurance ID number

• Date of service

• Patient’s name

• Total charges

Which field on the CMS-1500 form is used to enter the insured’s policy or group number?

• Field 1

• Field 1a

• Field 2

• Field 4

Where do you enter the patient’s date of birth on the CMS-1500 form?

• Field 2

• Field 3

• Field 5

• Field 12

Which field is used to enter the provider’s National Provider Identifier (NPI) on the CMS-1500 form?

• Field 17a

• Field 23

• Field 24J

• Field 33a

If the service was provided by a rendering provider different from the billing provider, where should their NPI be entered?

• Field 17

• Field 24J

• Field 26

• Field 33a

Where should the CPT/HCPCS codes for procedures performed be entered on the CMS-1500 form?

• Field 19

• Field 21

• Field 24D

• Field 32

Which field on the CMS-1500 form is used to report the patient's primary diagnosis?

• Field 21

• Field 24D

• Field 31

• Field 33

In which field is the patient's relationship to the insured entered?

• Field 7

• Field 11

• Field 6

• Field 23