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23 Cards in this Set
- Front
- Back
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Physician services for inpatient care are billed on a fee-for-service basis, and physician submit ..... service/procedure codes to payers
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CPT/HCPCS level II
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A patient developes surgical complication and returns to the O.R. to undergo surgery related to the original procedure. The return surgery is....
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billed as an additional surgical procedure
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Outpatient surgery and surgeon charges for inpatient surgery are billed according to a global fee, which means that the presurgical evaluation and management, initial and subsquent hospital visits, surgical procedure, discharge, and follow-up care in surgicans office are billes as
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one charge
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when 1 charge covers presurgical evaluation and managment, initial and sunsequent hospital visits, surgical procedure, the discharge visit, and umcomplicated postoperative follow-up care un the surgeon's office, this is called a(n)
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global fee
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Which situation requires the provider to write a letter explaining special circumstances?
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a patient's inpatient stay was prolonged because of medical or psychological complications
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the optical character reader (OCR) is a device that is used to...
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view CMS-1500 text
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when entering patient claims data onto the CMS-1500 claim, enter alpha characters using....
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upper case.
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which statement is an accurate interpretation of the phrase "assignment of benefits"? If signed by the patient on the CMS-1500 claim
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the payer is instructed to reimburse the provider directly.
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When an X is entered in one or more of the YES boxes in Block 10 of the CMS-1500 claim, payment might be the responsibility of a ...... insurace company.
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homeowner's
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The billing entity, as reported in Block 33 of the CMS-1500 claim, includes the legal business name of the.....
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medical practice.
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HIPPA privacy standrads require providers to notify patient about their right to .....
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privacy
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Development of an insurance claim beging when the .....
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patient contacts the provider's office and schedules an appointment
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Which of the following is true?
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Outpatient observation care can be converted to inpatient admission
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When a fee submitted to an insurace company is higher than the healthcare provider's normal fee for the coded procedure, the provider must....
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attach a letter to the claim to aid in determination for appropriate payment.
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Optical character reader (OCR) guidelines were established when the.....
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CMS-1500 claim form was developed.
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When typewritten data in a CMS-1500 claom run over into adjacent blocks, the claim will be....
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rejected (and the provider should correct and resubmit).
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Which is the correct way to enter the amount of $125.75 on the CMS-1500 claim?
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125 75
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A patient's name on the insurance card reads Marvin L. Blue III. How is this entered on the CMS-1500 claim?
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Blue III, Marvin, L
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Which is the proper way to report a patient's birth date of June 16, 1967, on CMS-1500 claim?
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06 16 1967
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Which is the proper way to prepare a rejected claim for resubmission?
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Create the corrected claim on an original (red-print) claim form.
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You are a health insurace specialist and have printed a batch of claims from your computer onto pin-fed paper. Which is the next step before placing the claims in the envelope?
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Perforate the borders and seperate each claim.
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Secondary diagnosis codes are reported on the CMS-1500 claim if they ......
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justify the procedures/services listed in block 24.
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Data are required by all payers in which block of the CMS-1500 claim, the first-listed code is the....
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reason the patient was treated by the provider
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