Forms - Locum tenens & reciprocal agreement

Question 1

What is the term for a temporary substitute especially for a doctor or member of clergy?
1. Locum tenets
2. Stand-in
3. Local Tenent
4. Temporary clergymen

Answer 1

1 Locum Tenents

Question 2

Locum Tenend & reciprocal agreements applying in the situation like weekends when the provider is on vacation or absence
True or false

Answer 2

True

Question 3

a substitute physician can be paid for the services provided to a Medicare patient under what conditions
1. A regular physician is able to provide the service.
2. A patient has not previously scheduled appointments or treatment with a regular physician.
3. A physician does not provide services to the patient for more than 30 days
4. None of the above

Answer 3

1. The regular physician is.UNABLE TO PROVIDE THE SERVICES
2. The patient HAS previously scheduled appointments or treatment with the regular physician.
3. The substitute position does not provide services to the patient for more THAN 60 DAYS.

Question 4

Which form below is not a common used form to complete the billing collection activities within the revenue cycle
1. UB-04 and 837I
2. CMS-1500 and 837P
3. Itemized statements.
4. DATA transmitter – statements
5. Medicare summary notice. MSN
6. Explanation of benefits, EOB or remittance advice, RA and an 835.

Answer 4

2. CMS-1500 and 837P
   6 Data mailer/statements

Question 5

Which of the following differences between the UB04 and 837I forms is not true
1. The UB04 formats have distinct FL #’s and names assigned to each data elemet reported
2. The 837I formats do not distinctly differentiate between patient data and subscriber data
3. The UB04 contains 81 data elements and reports important info about treatment and condition of patientt.

Answer 5

2. The **UB04 ** is the form that does not distincly differentiate between patient data and subscriber data

Question 6

Which form refers to the hardcopy version of the hospital claim form
1. UB - 04
2. 837p
3. 837I
4 CMS-1500


Answer 6

1. UB –04.

Question 7

Which form refers to the data set that is utilized in electronic submitting claims to appear
 837 I. Or 837P.

Answer 7

837 I

Question 8

The paper version of the 837I is divided into boxes called fuel locators while the electronic version is divided into loops and segments

Answer 8

True

Question 9

The DATA in the form locator/#DATA segment changes depending on the circumstances of the claim
true or false

Answer 9

 true

Question 10

Which one is not a difference between the paper, UB format and the electronic 8371 I select all that apply
1. The UB- 04formats have several distinct FL numbers and names designed to each data element reported.
2. The UB form consists of 81 data elements and report important information about the treatment and condition of the patient.
3 the UB four minutes, do not distinctly differentiate between patient data and subscriber data.

Answer 10

3. The UB before mass do not distinctly differentiate between the patient data and the subscriber data.
4. Was not true because it’s the UB format have distinct FL numbers not UB - 04.
5. Was not true because it was the UB -04 form that contains 81 data elements

Question 11

What is another name of the UB-04 form

1. CMS 1305
2. CMS 1205
3. CMS 1350
4. CMS 1450

Answer 11

4 CMS - 1450

Question 12

This form contains 81 data elements and reports important info about the treatment and condition of patient.
1. CMS- 1500
2. 837I
3. UB-04

Answer 12

UB 04

Question 13

Who uses the codes on the UB-04 mostly to obtain the providers detailed information regarding the need for medical services on an inpatient or outpatient basis
1 Medicaid
2. Medicare

Answer 13

2 Medicare

Question 14

The codes on a UB-04 are used to define which of the following (select all that do not apply)
1. significant events
2. insurance non-coverage conditions
3. Clinical or monetary data that may not affect payers processing and payment of the claim.
4. Insurance coverage conditions

Answer 14

2. Insurance COVERAGE conditions
3. Clinical or monetary data that may AFFECT payer processing or payment of claims.

Question 16

T of F

Medicare uses the UB04 to obtain provider detailed info regarding the need for medical services on an inpatient or outpatient basis.

Answer 16

True

Question 17

What forms have the most common E&M codes, procedures, and diagnosis codes preprinted on them?
1. UB04
2. Superbill
3. CMS-1500

Answer 17

2. Superbill

Question 18

This bill know as the encounter form is the sheet used to record certain data related to the patient encounter.
1. UB04
2. Superbill
3. CMS-1500

Answer 18

(2 Superbill

Question 19

This billing form is used to submit physician and professional services claims
1. UB04
2. Superbill
3. CMS-1500

Answer 19

(3 CMS-1500

Question 20

The Administrative Simplification compliance Act requires that Medicare claims be sent electronically unless certain exceptions are met.

Answer 20

True

Question 21

What form is used when providers send professional claims to medicare on paper
1. UB04
2. Superbill
3. CMS-1500

Answer 21

(3 CMS - 1500

Question 22

Which form is printed in red ink
1. UB04
2. Superbill
3. CMS-1500

Answer 22

(3 CMS-1500

Question 23

This billing form has an uniquely numbered for tracking. These should never be toss and should be accounted for at the end of each day.
1. UB04
2. Superbill
3. CMS-1500

Answer 23

(2 superbill

Question 24

What is one of the basic components in the PCP (Patient Care Partnership) brochure
most patient accounting systems produce an one of these after producing the claim form. (select all that apply)
1. Explanation of Benefits (EOB)
2. Itemized statement
3. Data Mailer
4. Remittance Advice (RA)

Answer 24

(2. The right to receive an itemized statement upon request and explanation of charges

Question 25

This form is a system generated, free form statement that is used to communicate the status of a patient's account / to bill the patient for an unpaid amout remaining on the account 1. Medicare Summary Notice 2. itemized statement 3. Data Mailer 4. Remittance Advice (RA)

Answer 25

(2 Data Mailer / Statement

Question 26

This is a quartly statement to payee/beneficiary reflecting services received, charges submitted, charges allowed, amounts for wihich the beneficiary is responsible, and the amount that was paid to the provider or beneficiary. These may specify deductible and coinsurance amounts. 1. Medicare Summary Notice (MSN) 2. Itemized statement 3. Data Mailer 4. Remittance Advice (RA)

Answer 26

1. Medicare Summary Notice (MSN)

Question 27

# T or F The Medicare Sumary Notice form (MSN) is also know as Remittance Advice and formerly as the Medicare Explaination of Benefits and are powerful fraud and abuse detection toos by actively enlisting beneficiaries to report suspected fraud and abuse.

Answer 27

TRUE

Question 28

This form(s) is a statement sent by a health insurance company to covered individuals explaining what medical treatments/services were paid for on their behalf. (Select all that apply) 1. Data Mailer 2. Explanation of Benefits (EOB) 3. Medicare Summary Notice (MSN) 4. Remittance (RA)

Answer 28

2. Explanation of Benefits (EOB) 4. Remittance (RA)

Question 29

T or F The only difference between the EOB and RA is: The RA may or may not have a check attached for payment of services The EOB should have a check attached or voucher for an electric payment which was made directly to the provider's bank

Answer 29

FALSE **the EOB may/may not have check attached for payment of services The RA SHOULD HAVE the check or voucher attached for an electronic payment made directly to provider**

Question 30

What is an Elecronic EOB called: 1. EEOB 2. EDI 835 files 3. 837R

Answer 30

(2 EDI 835 files

Question 31

What are some things the payment posting staff must understant on reading an EOB to ensure accurate payment posting 1. Know how to recognize contracted discounts 2. Identify the exact portion due by the beneficiary or secondary insurance 3. Both 1 and 2 4. none of the above

Answer 31

(3) Know how to recognize contracted discounts AND know how to identify the exact portion due by the beneficiary or secondary insurance

Question 32

EOB typically contain except 1. Payee, payer and Patient 2. Services Performed and details of service 3. Doc fees 4. Amt second insurance is responsible for 5. adjustment reason and codes 6. explanation of claims denial with info on how to start the appeal 7. all of the above

Answer 32

(4 amount the **PATIENT** is responsible for

Question 33

# ` T or F Healthcare provider and supplier are required to submit claims for services on byhalf of the beneficiary They can not charge a fee for this servie. Failure to comply can result in a Civil Monetary Penalty up to 500.

Answer 33

FALSE **UP TO 10,000. PER VIOLATION**

Question 34

Providers are not required to file claim for services when (select all that apply) 1. Medicare is listed as secondary 2. Payment from primary is sent to beneficiary 3. Beneficiary didn't provide the primary insurance info to submit the info for MSP 4. Beneficiary refused an ABN 5. All the above

Answer 34

1, 2, and 3 1. Medicare is listed as secondary 2. Payment from primary is sent to beneficiary 3. Beneficiary didn't provide the primary insurance info to submit the info for MSP 4. **Beneficiary SIGNED ABN**

Question 35

Which is not a reason for late charges to be occurred 1. system oricessung issued 2. Date entry error 3. Credit of unused medications 4. timeliness of charge entry

Answer 35

(2 Date entry error

Question 36

Medicare regulation requires all diagnostic and clinically related non-diagnostic outpatient services provided within 3 days of an inpatient admission to be combined to the inpatient claim when they are provided by an entity wholl owned or operated by the inpatient hospital, or another entity under arrangement with the admitting hospital. This is know as the 1. 1 Day and 3 Day payment Window Rule 2. 1 day association rule 3. 1 day 2 day window Rule

Answer 36

1. 1-Day and 3-Day Payment Window Rule

Question 37

What hospitals must comply with a similar rule that has a 1 day payment window. Select those that do not need to comply 1. Ambulance services 2. non-diagnostic outpatient not related to primary diagnosis provided with 3 days of the admission 3. Psychiatric 4. inpatient rehabilitation facilities 5. long term care 6. children's 7. Cancer 8. CAH

Answer 37

1. Ambulance services 2. non-diagnostic outpatient not related to primary diagnosis provided with 3 days of the admission 8 CAH

Question 38

Which are the benefits to electronic billing 1. Faster entry, less paper 2. Faster submission, proof of receipt 3. inability to sent attachments, upload/download issues 4. Less clerical error, faster receivables 5. 2 and 4

Answer 38

1, 2,3,

Question 39

The National correct coding Initiative (NCCI) identifies mutually exclusive CPT and HCPCS codes or thosethat should be billed together T or F

Answer 39

FALSE id's those that SHOULD NOT be billed together

Question 40

NCCI was introduced to do task which are not one of those tasks...select those that apply 1. Establish standars of medical billing 2. Id codes that may be a potential for fraud and abuse 3. Id codes that are not components of another codes but should be bundled.

Answer 40

3. They ID codes that are components of another code and should not be unbundled and billed on the same envcounter by the same provider.

Question 41

NCCI edit apply to 1. Physicians services 2. Hospital outpatients

Answer 41

NCCI - Physician Services under Medicare Physician Fee Schedule OCE - edits apply to hospital outpatient servies under the hospital OPPS

Question 42

OCE edits do (select those that do not apply) 1. Determine whather a specific code is payable under the Hospital OPPS 2. Include only a few of the CCI edits 3. Determine if the ASC limit applies to each bill

Answer 42

.2 They include MANY of the CCI edits

Question 43

The Medicare Code Editor (MCE) edits clams to detect errors in billing data being submitted by addressing 3 basic types of edits which is not one of the 1. Code edits - examine a record for correct use of ICD-10 codes 2. Coverage edits - examine the type of services and procedures 3. Clinical edits - examine the clinical consistency of procedural and diagnostic infor to determine if it is clinically irresponsible

Answer 43

.2 examines the type of PATIENT and the procedures .3 examine the clinical consistency of procedural and diagnostic infor to determine if it is clinically **RESPONSIBLE**

Question 44

MUE 1. Medical unnecessary expenses 2. Medically unlikely events 3. Most unlikely events 4. Medically unlikely Edits

Answer 44

4. Medically unlikely edits

Question 45

The MUE monitors 1. Prepayments 2. Receivables

Answer 45

Prepayments

Question 46

T or F MUE is a unit of service edit for HCPCS/CPT codes for services rendered by a provider to a single beneficiary on the same date of service

Answer 46

TRUE

Question 47

Can a MUE be appealed?

Answer 47

NO