Question 1

The code reported in Block 21A of the CMS-1500 claim is the major reason the patient was treated by the health care provider. It is called the __________ diagnosis.

Accepted Answer

A)   comorbid
B)   first-listed
C)   primary
D)   principalE) B) and D)
F) A) and C)

Question 2

Which is considered a nonphysician practitioner?

Accepted Answer

A)   nurse
B)   pharmacist
C)   physician assistant
D)   providerE) A) and B)
F) A) and C)

Question 3

The CMS-1500 paper claim was designed to accommodate optical scanning of __________ claims.

Accepted Answer

A)   electronic
B)   encrypted
C)   manual
D)   paperE) C) and D)
F) A) and B)

Question 4

Which was developed by the Centers for Medicare and Medicaid Services to assign the unique health care provider and health plan identifiers and to serve as a database from which to extract data?

Accepted Answer

A)   DOD OIG
B)   HIPAA
C)   ICD-10-CM
D)   NPPESE) None of the above
F) All of the above

Question 5

When a person uses a title such as Sr., Jr., II, or III, __________.

Accepted Answer

A)   always include it after entry of the person's last name on the CMS-1500 claim
B)   do not enter it on the claim unless printed on the patient's insurance ID card
C)   enter the title on the claim if instructed to do so by the patient or beneficiary
D)   verify the use of the title with the patient or guarantor before entering on the claimE) None of the above
F) A) and C)

Question 6

When completing the CMS-1500, enter a __________ for the dollar sign or decimal in all charges or totals and parentheses surrounding the area code in a telephone number.

Accepted Answer

A)   dash
B)   hyphen
C)   period
D)   spaceE) A) and D)
F) C) and D)

Question 7

Hospital inpatient charges are reported on the __________ claim.

Accepted Answer

A)   CMS-1500
B)   UB-92
C)   UB-02
D)   UB-04E) B) and C)
F) C) and D)

Question 8

HIPAA regulations require all payers to accept __________ attachments.

Accepted Answer

A)   electronic
B)   encrypted
C)   manual
D)   paperE) B) and D)
F) B) and C)

Question 9

Diagnoses must be entered in the patient's record to validate __________ of procedures or services billed.

Accepted Answer

A)   documentation
B)   frequency
C)   medical necessity
D)   submissionE) A) and D)
F) All of the above

Question 10

ICD-10-CM diagnosis codes are entered in Block 21 of the CMS-1500 claim. A maximum of __________ ICD-10-CM codes may be entered on a single claim.

Accepted Answer

A)   4
B)   8
C)   12
D)   16E) B) and C)
F) A) and D)

Question 11

Provider services for inpatient care are billed on a fee-for-service basis, and service results in a unique and separate charge designated by a __________ or HCPCS level II service/procedure code.

Accepted Answer

A)   CPT
B)   ICD-9-CM
C)   ICD-10-CM
D)   ICD-10-PCSE) A) and C)
F) A) and D)

Question 12

When entering codes for diagnoses on a CMS-1500 claim, qualified diagnosis codes (e.g., possible, probable)  are never reported. Instead, codes for the patient's __________ are entered.

Accepted Answer

A)   acute conditions
B)   chronic diagnoses
C)   laboratory tests
D)   signs or symptomsE) B) and D)
F) A) and B) D

Question 13

Secondary diagnoses codes are entered in Blocks __________ of the CMS-1500 claim.

Accepted Answer

A)   21B - 24L
B)   24EC) A) and B)
D) undefined

Question 14

Which occurs when a physician in the community refers a patient to the hospital for observation, bypassing the clinic or emergency department?

Accepted Answer

A)   direct admission
B)   emergency admission
C)   outpatient admission
D)   referred admissionE) B) and C)
F) None of the above A

Question 15

Which of the following health care professionals is permitted to bill a physician when that physician provides direct supervision of procedures/services?

Accepted Answer

A)   medical assistant
B)   nonphysician practitioner
C)   nurse
D)   pharmacistE) B) and C)
F) A) and D)

Question 16

When reporting procedures and services on the CMS-1500, list one procedure per line, starting with line one of Block 24. To report more than six procedures or services for the same date of service, __________.

Accepted Answer

A)   enter multiple codes on the same line in Block 24
B)   generate a new claim to enter more procedures/services
C)   increase the number of units entered in Block 24G
D)   use the shaded lines in Block 24 of the first CMS-1500E) B) and D)
F) B) and C)

Question 17

Diagnosis pointer letters A-L are preprinted in Block 21 of the CMS-1500 claim to allow for entry of __________ codes, and they are reported in Block 24E.

Accepted Answer

A)   CPT
B)   HCPCS level II
C)   ICD-10-CM
D)   ICD-10-PCSE) A) and C)
F) All of the above

Question 18

The optical scanning process uses a device that converts __________ characters into text that can be viewed by an optical character reader (OCR) .

Accepted Answer

A)   electronic
B)   encrypted
C)   manual
D)   printedE) B) and C)
F) A) and D)

Question 19

When entering a fee in Blocks 24F, 28, or 29, enter __________ in the cents column.

Accepted Answer

A)   1 zero
B)   2 zeros
C)   3 zeros
D)   no zerosE) A) and B)
F) A) and C) B

Question 20

Postoperative complications requiring a return to the operating room for surgery related to the original procedure are billed as an additional procedure, and the additional procedure is linked to __________.

Accepted Answer

A)   a new diagnosis that describes the complication
B)   an appropriate CPT or HCPCS level II modifier
C)   the diagnosis as the reason for original surgery
D)   surgical staff that performed the new procedureE) All of the above
F) B) and D)

Exam 11: Essential Cms-1500 Claim Instructions

The code reported in Block 21A of the CMS-1500 claim is the major reason the patient was treated by the health care provider. It is called the __________ diagnosis.

Correct AnswerverifiedShow Answer

Which is considered a nonphysician practitioner?

Correct AnswerverifiedShow Answer

The CMS-1500 paper claim was designed to accommodate optical scanning of __________ claims.

Correct AnswerverifiedShow Answer

Which was developed by the Centers for Medicare and Medicaid Services to assign the unique health care provider and health plan identifiers and to serve as a database from which to extract data?

Correct AnswerverifiedShow Answer

When a person uses a title such as Sr., Jr., II, or III, __________.

Correct AnswerverifiedShow Answer

When completing the CMS-1500, enter a __________ for the dollar sign or decimal in all charges or totals and parentheses surrounding the area code in a telephone number.

Correct AnswerverifiedShow Answer

Hospital inpatient charges are reported on the __________ claim.

Correct AnswerverifiedShow Answer

HIPAA regulations require all payers to accept __________ attachments.

Correct AnswerverifiedShow Answer

Diagnoses must be entered in the patient's record to validate __________ of procedures or services billed.

Correct AnswerverifiedShow Answer

ICD-10-CM diagnosis codes are entered in Block 21 of the CMS-1500 claim. A maximum of __________ ICD-10-CM codes may be entered on a single claim.

Correct AnswerverifiedShow Answer

Provider services for inpatient care are billed on a fee-for-service basis, and service results in a unique and separate charge designated by a __________ or HCPCS level II service/procedure code.

Correct AnswerverifiedShow Answer

When entering codes for diagnoses on a CMS-1500 claim, qualified diagnosis codes (e.g., possible, probable) are never reported. Instead, codes for the patient's __________ are entered.

Correct AnswerverifiedD

Secondary diagnoses codes are entered in Blocks __________ of the CMS-1500 claim.

Correct AnswerverifiedShow Answer

Which occurs when a physician in the community refers a patient to the hospital for observation, bypassing the clinic or emergency department?

Correct AnswerverifiedA

Which of the following health care professionals is permitted to bill a physician when that physician provides direct supervision of procedures/services?

Correct AnswerverifiedShow Answer

When reporting procedures and services on the CMS-1500, list one procedure per line, starting with line one of Block 24. To report more than six procedures or services for the same date of service, __________.

Correct AnswerverifiedShow Answer

Diagnosis pointer letters A-L are preprinted in Block 21 of the CMS-1500 claim to allow for entry of __________ codes, and they are reported in Block 24E.

Correct AnswerverifiedShow Answer

The optical scanning process uses a device that converts __________ characters into text that can be viewed by an optical character reader (OCR) .

Correct AnswerverifiedShow Answer

When entering a fee in Blocks 24F, 28, or 29, enter __________ in the cents column.

Correct AnswerverifiedB

Postoperative complications requiring a return to the operating room for surgery related to the original procedure are billed as an additional procedure, and the additional procedure is linked to __________.

Correct AnswerverifiedShow Answer

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D

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A

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B

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