Chapter 25 — Quiz
26 questions. Answers and explanations are in the instructor guide.
1. The CMS-1500's electronic equivalent is the:
- A. 837I
- B. 837P
- C. 835
- D. 270
2. The form is maintained by:
- A. CMS alone
- B. The National Uniform Claim Committee
- C. The AMA
- D. Each Medicare Administrative Contractor
3. A paper claim is printed in red drop-out ink because:
- A. It is a legal requirement of the Privacy Rule
- B. The scanner is calibrated not to see the form's own lines
- C. It distinguishes originals from copies
- D. It prevents alteration
4. The insured's name goes in item:
- A. 2
- B. 4
- C. 7
- D. 11
5. Items 10a–10c ask whether the condition is related to:
- A. A pre-existing condition
- B. Employment, an auto accident, or another accident
- C. A hospital admission
- D. A prior authorization
6. "Signature on file" in items 12 and 13:
- A. Is always acceptable
- B. Asserts that a signed authorization exists and is current
- C. Replaces the need for an authorization
- D. Is required by the NUCC
7. The referring provider's NPI goes in item:
- A. 17
- B. 17a
- C. 17b
- D. 24J
8. How many diagnosis codes fit in item 21?
- A. Four
- B. Six
- C. Eight
- D. Twelve
9. Item 21's diagnoses are labeled:
- A. 1 through 12
- B. A through L
- C. I through XII
- D. By ICD chapter
10. A claim is resubmitted to correct an error and item 22 is left blank. The payer receives:
- A. A corrected claim
- B. A duplicate
- C. A void
- D. An appeal
11. Item 23 may contain:
- A. The prior authorization number or the CLIA number
- B. The referring provider's NPI
- C. The diagnosis pointer
- D. The total charge
12. How many service lines does the form have?
- A. Four
- B. Six
- C. Ten
- D. Twelve
13. How many modifiers fit on a service line?
- A. Two
- B. Three
- C. Four
- D. Six
14. How many diagnosis pointers per service line?
- A. Two
- B. Four
- C. Six
- D. Twelve
15. Item 24F contains:
- A. The allowed amount
- B. The expected payment
- C. The practice's charge
- D. The patient's responsibility
16. The shaded upper portion of a service line carries:
- A. Nothing; it is decorative
- B. Supplemental information including NDC data for drug lines
- C. The diagnosis codes
- D. The rendering provider's address
17. A service line is pointed at a diagnosis that does not support it, while a supporting diagnosis appears elsewhere on the claim. The line:
- A. Pays
- B. Denies
- C. Pends
- D. Pays at a reduced rate
18. The rendering provider identified in 24I/24J is:
- A. Always an organization
- B. An individual — the person who performed the service
- C. The referring physician
- D. The billing entity
19. A Type 2 NPI identifies:
- A. An individual provider
- B. An organization
- C. A facility location only
- D. A taxonomy
20. An NPI proves:
- A. Enrollment with the payer
- B. Eligibility to be paid
- C. Identity, and nothing else
- D. Specialty
21. (Chapter 15) On a claim that qualifies for incident-to, item 24J should carry:
- A. The non-physician practitioner's NPI, paid at 85%
- B. The supervising physician's NPI, paid at 100%
- C. The billing organization's Type 2 NPI
- D. Both NPIs
22. Item 32 is required when:
- A. Always
- B. The service was performed somewhere other than the billing address
- C. The patient is a Medicare beneficiary
- D. A referral was obtained
23. Item 27, accept assignment, means the provider agrees to:
- A. File the claim electronically
- B. Accept the allowed amount as payment in full
- C. Waive the patient's coinsurance
- D. Accept any payment offered
24. A payer's companion guide states:
- A. What each item on the form is for
- B. How that payer requires the standard transaction to be populated
- C. The national coverage determinations
- D. The fee schedule
25. On Account 10-4471's claim, item 17 is:
- A. The performing physician
- B. Blank, because nobody referred her
- C. The patient's employer
- D. The rendering provider's NPI
26. On the same claim, line 4 (36415) points at diagnosis:
- A. A — the knee
- B. B — the diabetes
- C. C — the hypertension
- D. All four