CMS-1500 Health Insurance Claim Form Questions With 100% Correct Answers.

HCFA stands for : - Health Care Financing Administration The HCFA-1500 paper health insurance form was developed in______ by ________________ : - 1975; Health Care Financing Administration (HCFA) The HCFA claim form was developed to be used by providers for what purpose? - Billing Medicare for outpatient services HCFA changed its name to what in July of 2001? - Center for Medicare and Medicaid Services (CMS) HCFA-1500 claim form was changed to this in July of 2001 : - CMS-1500 Universal Claim Form For EVERY patient, the patient's insurance company should be contacted to verify what? - 1) The patient's eligibility 2) Coverage is in effect 3) Which benefit plan the patient has The paper CMS-1500 claim form can be submitted via what means? - Mailed; or scanned & submitted Medicare & Medicaid claim forms may be submitted electronically using the : - 837P standardized encrypted format As of October 16, 2003, HIPAA required all claim forms to be submitted electronically with what exception? - Claims submitted to smaller companies Verification of eligibility, coverage, and insurance plan helps the billing specialist with what? - 1) Faster processing of the patient's services2) Knowing which expenses the patient is responsible for 3) Assisting in patient education of insurance coverage Electronic claims can be submitted in three ways. They are? - 1) Direct data entry 2) Dial-up telephone 3) Computer over the internet What is Direct Data Entry? - Data is electronically transmitted from a provider's computer system into a health insurer's computer system. What is a Clearinghouse? - A centralized, independent facility or entity that processes claims electronically to various insurance companies after receiving them from the provider. What does a Clearinghouse do with the claims PRIOR to submitting them to the insurance companies? - They separate the claims by carrier, scrub the claim checking for errors, & submit clean claims to the appropriate insurance company for payment. What does a Clearinghouse do with claims with missing or incorrect information? - Return it to the provider for correction. Info found in TOP portion of the CMS-1500? - Patient related info such as their name, address, date of birth, marital status, gender, insurance info, & possibly employer info if work related. Info found in BOTTOM half of the CMS-1500? - Provider's service & billing info, incl diagnosis & procedure codes, hospitalization dates, NPI & Tax ID numbers, etc.