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Where is the NPI on the CMS-1500? 17b TERM 2 By signing item number 12, a patient is authorizing what? DEFINITION 2 the release of medical information needed to process a claim. TERM 3 Why are claims important? DEFINITION 3 Claims are important because it has all the necessary information third-party payers need to reimburse for services rendered TERM 4 What is transmitting claims? DEFINITION 4 Transmitting claims involves sending required information to third-party payers for reimbursement TERM 5 What is ASCA? DEFINITION 5 Administration Simplification Compliance Act, In 2012 the ASCA, part of HIPAA, announced the acceptance of electronic claim submissions (aka 837)
What is Medicare's transaction standard form? X12N version of 5010 TERM 7 Name 2 of Medicare's electronic forms DEFINITION 7 Facilities - 837IPhysicians (Professionals) - 837P TERM 8 Name 2 of Medicare's paper forms DEFINITION 8 Facilities - CMS-1450Physicians (Professionals) - CMS- 1500 TERM 9 True or False? Medicare claim must be submitted one year from the date of service DEFINITION 9 True TERM 10 what is a crossover claim? DEFINITION 10 A crossover claim is referencing when a patient's both primary insurance is Medicare and the secondary insurance is Medicaid.with crossover claims the first receipt receives the bill first and applies the deductible/coinsurance or copayment amount, and then automatically forwards the claim to the second receipt. the second receipt does not need to apply separate deductible/coinsurance or copayment.
What is a claim? a claim is a complete record of all the services provided to a patient TERM 17 the ASCA has one exception, what is it? DEFINITION 17 If the provider runs claims through a clearinghouse. then, a paper format (aka CMS-1500) claim draft may be submitted. TERM 18 What is the NPI number? DEFINITION 18 Under HIPAA Simplification Rule, the NPI number is a unique identification number for all HIPAA-covered entities, including ambulances organizations home health agencies clinics long-term care facilities residential treatment centers laboratories HMOs group practices TERM 19 Collecting copayments is during which step in the billing cycle? DEFINITION 19 Step 3, check-in patients(It can also be during check-out, Step ___) TERM 20 What is the first step in establishing financial responsibility? DEFINITION 20 Verify the payer's rules for the medical necessity of the planned services
What is the process when you create a claim while the patient is being checked out and receive an immediate response from the payer? (RTCA) Real Time Claim Adjudication TERM 22 True or False Establish patients review and update information that is on file DEFINITION 22 True TERM 23 The MPFS is based on? DEFINITION 23 The Medicare Physician Fee Schedule is based on the Resource Based Relative Value Scale (RBRVS) fees TERM 24 The UOS edits that CMS uses are called DEFINITION 24 (MUEs) Medically Unlikely Edits TERM 25 What are the three components of an RBRVS fee? DEFINITION 25 The uniform value, GPCI, and conversion factor
When the patient and insured are not the same person, what code is used to indicate this? individual relationship indicator code TERM 32 What is the purpose of the shading in the top six service lines in section 24 of the CMS- claim? DEFINITION 32 to allow for six lines of service TERM 33 You are working at a practice and need to decide whether or not you may release a medical document about a patient in order to process a claim. Determine where to find this information on the CMS- DEFINITION 33 Item number 12 TERM 34 Name the qualifier used to indicate a provider's taxonomy number DEFINITION 34 the qualifier is zz TERM 35 Medicare health insurance claim number is assigned to who? DEFINITION 35 A Medicare enrollee
