Lucky Luciano's Insurance: Chapter 11 Cms-1500
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- 1.Physicians services for inpatient care are billed on a fee-for-service basis, and physicians submit _______ service/procedure codes to payers.
- A.
CPT/HCPCS level II
- B.
DSM-IV-TR
- C.
HCPCS level III
- D.
ICD-9-CM ( or ICD-10-CM)
- 2.A patient develops surgical complications and returns to the operating room to undergo surgery related to the original procedure. The return surgery is
- A.
Billed as an additional surgical procedure
- B.
Coded for office data capture purposes only
- C.
Included as part of the original procedure
- D.
Not reported on the CMS-1500 or UB-04
- 3.
- A.
DRG payments
- B.
Multiple charges
- C.
One charge
- D.
Separate charges
- 4.When one charge covers pre surgical evaluation and management, initial and subsequent hospital, surgical procedure, the discharge visit, and uncomplicated postoperative follow up care in the surgeons office, this is called a
- A.
Combined medical/surgical case
- B.
Fee-for service charge
- C.
Global fee
- D.
Itemized list of separate charges
- 5.Which situation requires the provider to write a letter explaining special circumstances?
- A.
A patients inpatient stay was prolonged due to medical or psychological complications.
- B.
Charges submitted to the payer are lower than the providers normal fee( -22 added to code)
- C.
Surgery defined as an inpatient procedure was performed while the patient was in the hospital
- D.
Surgery typically categorized as an office procedure was performed in a hospital outpatient setting
- 6.An optical character reader (OCR) is a device that is used to
- A.
Convert CMS-1500 claims
- B.
Enter CMS-1500 claims
- C.
Scan CMS-1500 claims
- D.
View CMS-1500 claims
- 7.When entering patient claims data onto the CMS-1500 claim, enter alpha characters using
- A.
Lower case
- B.
Sentence case
- C.
Title case
- D.
Upper case
- 8.Which statement is an accurate interpretation of the phrase "assignment of benefits"? If signed by the patient on the CMS-1500 claim
- A.
The payer is instructed to reimburse the provider directly
- B.
The payer sends reimbursement for services to the patient
- C.
The provider accepts as payment what the payer reimburses
- D.
The provider cannot collect copayments from the patient
- 9.The billing entity as reported on block 33 of the CMS-1500 claim, includes the legal business name of the
- A.
Acute care hospital
- B.
Insurance company
- C.
Medical practice
- D.
Patient or (spouse)
- 10.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 _______ insurance company
- A.
Disability
- B.
Homeowners
- C.
Life
- D.
Managed care
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