Questions and Answers
What is a device that can read typed characters at very high speed and convert them to digitized files known as?
What is an insurance claim submitted to an insurance carrier that is discarded by the system because of erroneous information known as?
Rejected Claim
What is a completed insurance claim form that contains all the necessary information without deficiencies for processing called?
Clean Claim
What is a Medicare claim that contains complete, necessary information but is illogical or incorrect known as?
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What is an insurance claim held in suspense because of a review known as?
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What is a claim submitted with errors or requiring manual processing known as?
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What is an insurance claim submitted to the insurance carrier via computer known as?
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What is an insurance claim submitted on paper, including those optically scanned, known as?
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What is a Medicare claim missing required information and returned to the provider for resubmission known as?
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What is an insurance claim with no stapled or highlighted areas known as?
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What is the insurance coverage of an insured under two or more policies known as?
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The HIPAA transactions and code sets standards apply to what?
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What is the field or block on the claim form labeled to identify the location in which a medical service or procedure was performed?
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How many modifiers are allowed in Block 24D of the CMS-1500 (02-12) claim form?
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Which block is used for calculating multiple visits and/or the number of miles on the CMS-1500 (02-12) claim form?
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What is the appropriate method for reporting the service date on a claim form?
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What is the translation for the abbreviation EIN?
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What does CMS-1500 (02-12) stand for?
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What is the translation for the abbreviation ICR?
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What does NPI stand for?
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What is the translation for the abbreviation OCR?
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What does SOF stand for?
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What is the translation for the abbreviation SSN?
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What is a number assigned to a group of physicians submitting insurance claims under the group name known as?
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What is the number used when submitting bills for specific medical supplies to the Medicare fiscal intermediary?
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What is the number issued to a physician who has passed the state medical examination known as?
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What is an individual's federal tax identification number issued by the IRS for income tax purposes known as?
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What is an individual's tax identification number issued by the federal government known as?
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What is a hospital's provider number that may be used by the facility for billing known as?
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What is a Medicare lifetime 10-digit number issued to providers known as?
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You should not fold or crease an insurance form that will be optically scanned.
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A patient's nickname may be shown on a CMS-1500 (02-12) claim form.
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A narrative description of each medical service or procedure is not required on the CMS-1500 (02-12) claim form.
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It is appropriate to insert dollar signs when listing charges on a CMS-1500 (02-12) claim form.
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Study Notes
Insurance Claims Types
- Intelligent Character Recognition (ICR) & Optical Character Recognition (OCR): Technologies used for reading typed characters and digitizing them rapidly.
- Rejected Claim: An insurance claim discarded due to erroneous information.
- Clean Claim: A completed claim form with all necessary details, allowing for prompt processing and payment.
- Invalid Claim: A Medicare claim that is complete but contains incorrect or illogical information.
- Pending Claim: An insurance claim held for review or further examination.
- Dirty Claim: A claim submitted with errors requiring manual intervention for resolution.
- Electronic Claim: A claim submitted electronically to the insurance carrier.
- Paper Claim: A claim submitted in paper form, which may later be scanned and converted to electronic format.
- Incomplete Claim: A Medicare claim lacking required information and returned to the provider.
Claim Form Characteristics
- Physically Clean Claim: An insurance claim that has no highlight or attached items.
- Dual Coverage: Insurance coverage under two or more policies for an insured individual.
- Place of Service: The label on the claim form identifying where medical services were provided.
- Block 24D Limit: Four modifiers can be reported in Block 24D of the CMS-1500 (02-12) claim form.
- Block 24G: Utilized for calculating multiple visits or mileage.
Reporting and Abbreviations
- Service Date Reporting: Should be formatted as MMDDYYYY (e.g., 05072016).
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Abbreviations:
- EIN: Employer Identification Number.
- CMS-1500 (02-12): Centers for Medicare and Medicaid Services Health Insurance Claim Form-1500 (02-12).
- NPI: National Provider Identifier.
- SSN: Social Security Number.
- SOF: Signature on file.
- OCR: Optical Character Recognition.
Additional Identifiers
- Group NPI: Assigned to a group of physicians submitting claims under one name.
- Durable Medical Equipment Number: Used for billing specific medical supplies to Medicare.
- State License Number: Indicates a physician's right to practice medicine in their state.
- Facility Provider Number: Used by hospitals for billing services performed there.
- 10-digit Medicare Number: Assigned to providers for identification.
Claim Form Guidelines
- Claims should not be folded or creased as it may affect optical scanning.
- Patient nicknames are not permitted on the CMS-1500 (02-12) claim form.
- Narrative descriptions of medical services or procedures are not required on the claim form.
- Dollar signs should not be used when listing charges on the CMS-1500 (02-12) claim form.
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Description
Test your knowledge on Chapter 7 of the Paper Claim CMS-1500 with these flashcards. This quiz covers key concepts such as character recognition and types of insurance claims. Perfect for anyone preparing for medical billing and coding exams!
