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Medical Insurance Claims
18 Medical Insurance Claims
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The health insurance claim form provides communication between the insurance company and the physician for the services the patient has received True False
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To ensure prompt processing of a claim
The proper forms must be used The information must be accurate It must be submitted to the correct carrier All of the above
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A CMS-1500 claim form used to be referred to as HCFA-1500
True False
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Most insurance carriers will only accept paper claims for
New claims Resubmitted claims If the claim requires documentation None of the above
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All of the following are claim form numbers except
HCFA 1500 CMS 1500 BCBS 04 UB 04
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CMS 1450 forms are used to submit claims from
Skilled nursing facilities Home health agencies A and B None of the above
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Using the incorrect form will not cause the claim to be rejected
True False
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Medical assistants must stay current with their knowledge regarding Medicare
Policies, Coverage Benefit period All of the above
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Medicare will accept only claims submitted on a CMS 1500
True False
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Medicare is a governmental insurance program for those individuals who are considered medically indigent True False
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Military claims can be processed on
DD form 2642 CMS 1500 UB-04 Any of the above
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Most insurance carriers require that claims be submitted electronically
True False
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When a claim form contains an error and is rejected by the insurance carrier, the claim form must be corrected and resubmitted for payment True False
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Disadvantages of paper claim submissions includes
Postage Processing time Resubmission All of the above
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The Health Insurance Portability and Accountability Act (HIPAA) required that claims be transmitted electronically for most facilities by October 16, 2003 True False
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Electronic claim submission reduces processing time and often results in faster payment
True False
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A health insurance claim form that has been completed correctly without any errors or omissions is called Clean claim Dirty claim Invalid claim None of the above
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Clean claim Dirty claim Invalid claim None of the above
When a health insurance claim form is incorrect because it has missing data or errors, it is considered to be incomplete and a Clean claim Dirty claim Invalid claim None of the above
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A health insurance claim form that has been completed but has some type of incorrect information is considered an Clean claim Dirty claim Invalid claim None of the above
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In addition to information about the patient, the diagnosis, and the services received the claim must also include The name of the insured’s insurance company The name of the insured The insured’s identification number All of the above
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