Question 1

For the release of information to be permissible, signature on file must have been obtained

Accepted Answer

A)   within two years.
B)   within six months.
C)   within three years.
D)   within 12 months.

Question 2

You are working at a medical practice and have been requested to resubmit a claim to replace one that was sent the previous week. Determine what claim frequency code should be applied to the claim.

Accepted Answer

A)   1
B)   no frequency code is required
C)   8
D)   7

Question 3

Physicians identify their medical specialty by using

Accepted Answer

A)   administrative codes.
B)   place of service codes.
C)   taxonomy codes.
D)   diagnosis codes.

Question 4

What EPSDT code is used to report New Service Requested?

Accepted Answer

A)   S2
B)   NU
C)   ST
D)   AV

Question 5

Which of the following benefits do medical insurance specialists gain by becoming familiar with the information most often required on claims their practice prepares?

Accepted Answer

A)   learning anatomy and physiology
B)   learning medical terminology
C)   ability to memorize a set claim completion process
D)   ability to respond to payers' questions

Question 6

What item is not included in the patient information section lines 1-13 of the CMS-1500?

Accepted Answer

A)   the health plan
B)   the insured
C)   the patient
D)   the diagnosis

Question 7

What organization determines the content of both HIPAA 837 and CMS-1500 claims?

Accepted Answer

A)   HIPAA
B)   NPI
C)   NUCC
D)   CMS

Question 8

Identify the important step that immediately precedes claim transmittal.

Accepted Answer

A)   getting patient approval
B)   checking the claim
C)   notifying the patient
D)   notifying the payer

Question 9

Which of the following skills are required of medical insurance specialists in completing claims?

Accepted Answer

A)   critical thinking skills and A/P
B)   medical terminology and memorization
C)   memorization
D)   organizational skills and good thinking skills

Question 10

Name the current paper claim approved by the NUCC.

Accepted Answer

A)   CMS-1500
B)   CMS-1500 (02/12) 
C)   837
D)   HIPAA 837 claim

Question 11

What character should be used in Item Number 24F if the encounter was under an MCO capitation contract?

Accepted Answer

A)   C
B)   0
C)   both C and 0
D)   $ B

Question 12

The responsible party is held accountable for

Accepted Answer

A)   the financial responsibility for a bill.
B)   the correct completion of the HIPAA 837.
C)   the correct assignment of codes.
D)   the submission of the electronic claim.

Question 13

What are the five sections on a claim?

Accepted Answer

A)   provider, claim details, diagnosis, procedure, payer
B)   provider, payer, diagnosis, clearinghouse, subscriber
C)   provider, subscriber, payer, claim details, services
D)   provider, clearinghouse, payer, claim details, diagnosis

Question 14

Explain the purpose of Item Number 10a-10C on the CMS-1500.

Accepted Answer

A)   to determine liability for the condition
B)   to determine the need for additional services
C)   this field is not required
D)   to determine the patient's availability for appointments A

Question 15

Examine the following entities and determine which may act as a billing provider.

Accepted Answer

A)   only a billing service and clearinghouse
B)   only a practice and billing service
C)   only a clearinghouse and practice
D)   a clearinghouse, practice, and billing service

Question 16

What is sent as additional data to support a claim?

Accepted Answer

A)   attachment
B)   National Uniform Claim Committee number
C)   PHI
D)   procedure code

Question 17

A data element that HIPAA mandates reporting under certain conditions is called a(n)

Accepted Answer

A)   NRUC data element.
B)   situational data element.
C)   not required data element.
D)   required data element.

Question 18

Identify the person or organization that receives payment.

Accepted Answer

A)   the destination payer
B)   the referring provider
C)   the billing provider
D)   the pay-to provider

Question 19

Where is the carrier block located on the CMS-1500?

Accepted Answer

A)   upper left
B)   bottom left
C)   bottom right
D)   upper right D

Question 20

In which of these methods of transmitting claims can employees key standard data elements using an Internet-based service?

Accepted Answer

A)   direct data entry
B)   the adjudication process
C)   clearinghouse use
D)   direct transmission to the payer

Exam 7: Health Care Claim Preparation and Transmission

For the release of information to be permissible, signature on file must have been obtained

Correct AnswerverifiedShow Answer

You are working at a medical practice and have been requested to resubmit a claim to replace one that was sent the previous week. Determine what claim frequency code should be applied to the claim.

Correct AnswerverifiedShow Answer

Physicians identify their medical specialty by using

Correct AnswerverifiedShow Answer

What EPSDT code is used to report New Service Requested?

Correct AnswerverifiedShow Answer

Which of the following benefits do medical insurance specialists gain by becoming familiar with the information most often required on claims their practice prepares?

Correct AnswerverifiedShow Answer

What item is not included in the patient information section lines 1-13 of the CMS-1500?

Correct AnswerverifiedShow Answer

What organization determines the content of both HIPAA 837 and CMS-1500 claims?

Correct AnswerverifiedShow Answer

Identify the important step that immediately precedes claim transmittal.

Correct AnswerverifiedShow Answer

Which of the following skills are required of medical insurance specialists in completing claims?

Correct AnswerverifiedShow Answer

Name the current paper claim approved by the NUCC.

Correct AnswerverifiedShow Answer

What character should be used in Item Number 24F if the encounter was under an MCO capitation contract?

Correct AnswerverifiedB

The responsible party is held accountable for

Correct AnswerverifiedShow Answer

What are the five sections on a claim?

Correct AnswerverifiedShow Answer

Explain the purpose of Item Number 10a-10C on the CMS-1500.

Correct AnswerverifiedA

Examine the following entities and determine which may act as a billing provider.

Correct AnswerverifiedShow Answer

What is sent as additional data to support a claim?

Correct AnswerverifiedShow Answer

A data element that HIPAA mandates reporting under certain conditions is called a(n)

Correct AnswerverifiedShow Answer

Identify the person or organization that receives payment.

Correct AnswerverifiedShow Answer

Where is the carrier block located on the CMS-1500?

Correct AnswerverifiedD

In which of these methods of transmitting claims can employees key standard data elements using an Internet-based service?

Correct AnswerverifiedShow Answer

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B

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A

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D

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