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MindTap MA Ch 30 Test Yourself with Verified Answers
Providers have been urged to send claims
electronically since: - ANSWER -2005.
Misusing codes on a claim, such as upcoding or
unbundling codes, is an example of: -
ANSWER -Medicare fraud and abuse.
Prior to sending any claims to a third party for
reimbursement, you should be certain that you
have a copy of the patient's: - ANSWER -
insurance card.
A bill for secondary insurance coverage would be
created: - ANSWER -after the payment is
received from the primary insurer.
A provider can charge more than the Medicare-
approved amount, but there is a limit called ____
which is up to 15 percent over the amount that
nonparticipating providers are paid. -
ANSWER -"the limiting charge"
The amount of a non-covered service, the
deductible, or out-of pocket requirements is
noted on the EOB as: - ANSWER -not
allowed amount.
It is recommended that a patient's signature on
file be updated: - ANSWER -annually.
A ____ is a claim that is automatically forwarded
from Medicare to a secondary insurer after
Medicare has paid its portion of a service in the
EHR. - ANSWER -"crossover claim"
Which of these is the standard claim form used
for billing in medical offices? - ANSWER -
CMS-1500
A ____ is a book in which a list of insurance
claims is kept. - ANSWER -"manual
insurance log"
Whose Social Security number is used as the
insurance plan ID number? - ANSWER -
Policy holder
If a doctor, provider, or supplier doesn't accept
assignment of Medicare insurance, they are
referred to as ____ providers. - ANSWER -
"nonparticipatinh"
A(n) ____ must be in place in order to file a claim
electronically. - ANSWER -"Electronic Data
Interchange (EDI)"
If a patient is a member of a health insurance
plan operated by a payer that supports ____ , the
medical assistant would log into the payer's
website and enter the information on the visit.
Upon electronic receipt of the information, the
payer's system calculates the payment to the
provider and the amount owed by the patient,
and displays on the medical assistant's screen. -
ANSWER -"real time adjudication"
In some cases, the patient might have to submit
his or her own claim to Medicare, using Form
____ in order to receive reimbursement for the
costs. - ANSWER -CMS-1490S
____ means that the doctor, provider, or supplier
agrees (or is required by law) to accept the
Medicare-approved amount as full payment for
covered services. - ANSWER -Medicare
