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Health Insurance
HI chps 11-13
| Question | Answer |
|---|---|
| What is commonly assigned to patients who present to the ED and who then require a significant period of treatment or monitoring before a decision is made concerning their admission or discharge? | Observation status |
| What occurs when a physician in the community refers a patient to the hospital for observation, bypassing the clinic or ED? | Direct admission |
| What is one charge that covers presurgical evaluation and management, initial and subsequent hospital visits, surgical procedure, the discharge visit, and uncomplicated postoperative follow-up care? | Global fee or Global surgery package |
| Postoperative complications requiring a return to the operating room for surgery related to the original procedure are billed as an additional what? | Procedure |
| How are birth dates entered on the CMS-1500 claim? | As eight digits with spaces between the digits representing the month, day, and four-digit year. |
| How do you enter a provider on the CMS-1500 claim? | First name, middle initial (if known), last name, and credentials. Do not enter any punctuation. |
| What is a unique 10-digit number issued to individual providers and healthcare organizations? | National Provider Identifier |
| What is it called when the patient instructs the payer to directly reimburse the provider? | Assignment of Benefits |
| What is it called when the provider agrees to accept as payment in full whatever the payer reimburses? | Accept Assignment |
| How many ICD-9-CM codes may be entered on a single CMS-1500 claim? | Four |
| What is the POS (Point of Service) code used for physician's offices? | Eleven |
| How many procedures and/or services may be reported on a single CMS-1500 claim? | Six |
| Which procedure/service code should be entered first on the CMS-1500 claim? | The one with the highest fee. |
| What is the legal business name of a practice called? | Billing entity |
| What are supplemental plans designed by the federal government that are sold by private commercial insurance companies to "cover the gaps in Medicare"? | Medigap |
| When a child who is covered by two or more plans lives with his married parents, the primary policyholder is who? | The parent whose birthday occurs first in the year. |
| What type of text should be used to enter the data onto a CMS-1500 claim? | Upper case |
| What is an employer-sponsored health benefits program that was established by an Act of Congress in 1959? | FEHBP or FEP (Federal Employee Program) |
| What is the amount commonly charged for a particular medical service by providers within a particular geographic region for establishing the allowable rates? | Usual, customary, and reasonable (UCR) |
| What is an acceptable abbreviation for SIGNATURE ON FILE for box 12 on the CMS-1500 claim? | SOF |
Created by:
YTIMBC
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