MBC Ch. 16 Receiving payments & Problem Solving

If an insured is in disagreement with the insurer for settlement of a claim, a suit must begin within

• 1 year.

• 2 years.

• 3 years.

• 5 years.

The document together with the payment voucher that is sent to a physician who has accepted assignment of benefits is referred to as an

• EOB.

• EOMB.

• MRA.

• MPS.

When billing secondary insurances, which of the following is NOT true?

• The secondary insurance is billed at the same time the primary insurance is.

• Blocks 9a–d of the CMS 1500 claim form must be completed.

• Block 30 of the CMS 1500 claim form must be completed.

• If the MAC automatically forwards the claim to the secondary insurance, there is no need to bill the secondary insurance.

If an insurance claim appears to have been lost, the procedure(s) to follow is to

• contact the insurance company to check the claim status.

• submit a copy of the original claim.

• verify the correct mailing address.

• All are correct.

A submitted claim that does not follow specific third-party payer instructions or contains a technical error is referred to as

• paid.

• rejected.

• suspended.

• denied.

Identify the choice that best completes the statement or answers the question. Medical services which are performed primarily for the convenience of the patient or the health care provider would be denied as:

• an invalid service

• a nonspecific service

• not medically necessary

• a bundled procedure

The total number of levels of redetermination that exist in the Medicare program is

• two.

• three.

• five.

• six.

The correct method to send documents for a Medicare reconsideration (Level 2) is by

• certified mail with return receipt requested.

• certified mail.

• standard mail.

• overnight mail.

A request for a Medicare administrative law judge hearing can be made if the amount in controversy is at least

• $170.

• $250.

• $350.

• $500.

If a payment problem develops with an insurance company and the company ignores claims and exceeds time limits to pay a claim, it is prudent to contact the

• federal insurance commissioner.

• state insurance commissioner.

• state insurance federation.

• department of public service.