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23 Cards in this Set

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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
CPT/HCPCS level II
A patient developes surgical complication and returns to the O.R. to undergo surgery related to the original procedure. The return surgery is....
billed as an additional surgical procedure
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
one charge
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)
global fee
Which situation requires the provider to write a letter explaining special circumstances?
a patient's inpatient stay was prolonged because of medical or psychological complications
the optical character reader (OCR) is a device that is used to...
view CMS-1500 text
when entering patient claims data onto the CMS-1500 claim, enter alpha characters using....
upper case.
which statement is an accurate interpretation of the phrase "assignment of benefits"? If signed by the patient on the CMS-1500 claim
the payer is instructed to reimburse the provider directly.
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.
homeowner's
The billing entity, as reported in Block 33 of the CMS-1500 claim, includes the legal business name of the.....
medical practice.
HIPPA privacy standrads require providers to notify patient about their right to .....
privacy
Development of an insurance claim beging when the .....
patient contacts the provider's office and schedules an appointment
Which of the following is true?
Outpatient observation care can be converted to inpatient admission
When a fee submitted to an insurace company is higher than the healthcare provider's normal fee for the coded procedure, the provider must....
attach a letter to the claim to aid in determination for appropriate payment.
Optical character reader (OCR) guidelines were established when the.....
CMS-1500 claim form was developed.
When typewritten data in a CMS-1500 claom run over into adjacent blocks, the claim will be....
rejected (and the provider should correct and resubmit).
Which is the correct way to enter the amount of $125.75 on the CMS-1500 claim?
125 75
A patient's name on the insurance card reads Marvin L. Blue III. How is this entered on the CMS-1500 claim?
Blue III, Marvin, L
Which is the proper way to report a patient's birth date of June 16, 1967, on CMS-1500 claim?
06 16 1967
Which is the proper way to prepare a rejected claim for resubmission?
Create the corrected claim on an original (red-print) claim form.
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?
Perforate the borders and seperate each claim.
Secondary diagnosis codes are reported on the CMS-1500 claim if they ......
justify the procedures/services listed in block 24.
Data are required by all payers in which block of the CMS-1500 claim, the first-listed code is the....
reason the patient was treated by the provider