Question 1

Match the reason that the insurance claim was rejected with the possible solution to the problem.

-Patient's name and insured's name are entered as the same when the patient is a dependent.
A)Proofread numbers carefully from source documents.
B)Check for Sr., Jr., correct birth date, and verify the insured.
C)Refer to an updated diagnostic codebook and review the patient record.
D)Verify with the patient's medical record that all dates of service are listed and accurate.
E)Verify that the place of service is correct for the submitted procedure code(s) and fill in correct service code.
F)Refer to the current procedure codebooks and verify the coding system used by the insurance company.
G)Verify and submit valid modifiers with the correct procedure codes for which they are valid.
H)Total all charges on each claim, recheck the math, and verify amounts with the patient account.
I)Obtain data from patient during the first office visit on which company is the primary insurer.
J)Submit all attachments with patient's name and insurance identification number.

Accepted Answer

The solution to the problem of entering patient's name and insured's name as the same when the patient is a dependent is to check for Sr., Jr., correct birth date, and verify the insured.

Answer: I
 To avoid claim rejection due to incorrect information about the primary insurer, it is important to obtain data from the patient during the first office visit on which company is the primary insurer.

Answer: F
 If the insurance claim is rejected due to incorrect procedure code, it is important to refer to the current procedure codebooks and verify the coding system used by the insurance company.

Question 2

Match the type of insurance claim with the correct description.

-An insurance claim that is submitted on paper, including optically scanned claims.
A)Clean claim
B)Dirty claim
C)Electronic claim
D)Incomplete claim
E)Invalid claim
F)Paper claim
G)Pending claim
H)Rejected claim

Accepted Answer

A paper claim is a claim that is submitted on paper.

Answer: A 
 A clean claim is a claim that is free of errors or omissions and can be processed promptly without additional information from the healthcare provider.

Answer: C 
 An electronic claim is a claim that is submitted electronically, typically through a computer software program.

Answer: D 
 An incomplete claim is a claim that is missing information or documentation needed for processing.

Answer: E 
 An invalid claim is a claim that is submitted for services that are not covered by the insurance policy or that do not meet the criteria for coverage.

Answer: H 
 A rejected claim is a claim that is not paid by the insurance company due to errors or omissions on the claim or because it does not meet the criteria for coverage.

Answer: G 
 A pending claim is a claim that is being reviewed or investigated by the insurance company before a decision is made on payment or coverage.

Question 3

Match the type of insurance claim with the correct description.

-An insurance claim held in suspense due to review or other reason.
A)Clean claim
B)Dirty claim
C)Electronic claim
D)Incomplete claim
E)Invalid claim
F)Paper claim
G)Pending claim
H)Rejected claim

Accepted Answer

A pending claim is one that is held in suspense due to review or other reasons.

Possible additional answer:

Answer: H 
 A rejected claim is one that has been denied by the insurer and will not be covered.

Question 4

Match the type of insurance claim with the correct description.

-An insurance claim that requires investigation and needs further clarification.
A)Clean claim
B)Dirty claim
C)Electronic claim
D)Incomplete claim
E)Invalid claim
F)Paper claim
G)Pending claim
H)Rejected claim

Accepted Answer

The answer of Match the type of insurance claim with...

Question 5

Match the type of insurance claim with the correct description.

-A Medicare claim that is missing required information.
A)Clean claim
B)Dirty claim
C)Electronic claim
D)Incomplete claim
E)Invalid claim
F)Paper claim
G)Pending claim
H)Rejected claim

Accepted Answer

An incomplete claim is missing required information and cannot be processed.

Answer: H 
 A rejected claim has been reviewed and denied for payment due to errors or issues with the claim.

Answer: A 
 A clean claim contains all required information and can be processed efficiently without delays.

Answer: E 
 An invalid claim contains errors or inaccuracies that prevent it from being processed, such as incorrect patient or provider information.

Answer: F 
 A paper claim is a physical copy of a claim form that is mailed or faxed to the insurance company.

Answer: G 
 A pending claim is still under review and has not yet been processed or approved.

Question 6

Match the reason that the insurance claim was rejected with the possible solution to the problem.

-Operative report is missing from the insurance claim.
A)Proofread numbers carefully from source documents.
B)Check for Sr., Jr., correct birth date, and verify the insured.
C)Refer to an updated diagnostic codebook and review the patient record.
D)Verify with the patient's medical record that all dates of service are listed and accurate.
E)Verify that the place of service is correct for the submitted procedure code(s) and fill in correct service code.
F)Refer to the current procedure codebooks and verify the coding system used by the insurance company.
G)Verify and submit valid modifiers with the correct procedure codes for which they are valid.
H)Total all charges on each claim, recheck the math, and verify amounts with the patient account.
I)Obtain data from patient during the first office visit on which company is the primary insurer.
J)Submit all attachments with patient's name and insurance identification number.

Accepted Answer

The solution to a missing operative report from an insurance claim is to ensure all necessary attachments, including the operative report, are submitted with the patient's name and insurance identification number clearly indicated.

Question 7

Match the reason that the insurance claim was rejected with the possible solution to the problem.

-Missing place of service code.
A)Proofread numbers carefully from source documents.
B)Check for Sr., Jr., correct birth date, and verify the insured.
C)Refer to an updated diagnostic codebook and review the patient record.
D)Verify with the patient's medical record that all dates of service are listed and accurate.
E)Verify that the place of service is correct for the submitted procedure code(s) and fill in correct service code.
F)Refer to the current procedure codebooks and verify the coding system used by the insurance company.
G)Verify and submit valid modifiers with the correct procedure codes for which they are valid.
H)Total all charges on each claim, recheck the math, and verify amounts with the patient account.
I)Obtain data from patient during the first office visit on which company is the primary insurer.
J)Submit all attachments with patient's name and insurance identification number.

Accepted Answer

The insurance claim was rejected due to missing place of service code. The solution is to verify that the place of service is correct for the submitted procedure code(s) and fill in the correct service code.

Answer: C
 This solution relates to checking the diagnostic codes and patient record. The choices A, B, D, F, G, H, I, and J are not relevant to this specific problem.

Question 8

Match the type of insurance claim with the correct description.

-An insurance claim that is submitted within the program or policy time limit and correctly completed.
A)Clean claim
B)Dirty claim
C)Electronic claim
D)Incomplete claim
E)Invalid claim
F)Paper claim
G)Pending claim
H)Rejected claim

Accepted Answer

A clean claim is one that is submitted within the program or policy time limit and correctly completed.

Answer: B
 A dirty claim is a claim that is submitted with errors or missing information.

Answer: C
 An electronic claim is a claim that is submitted electronically.

Answer: D
 An incomplete claim is a claim that is missing required information or documentation.

Answer: E
 An invalid claim is a claim that does not meet the requirements for coverage under the policy.

Answer: F
 A paper claim is a claim that is submitted on paper.

Answer: G
 A pending claim is a claim that is being reviewed by the insurance company and a decision has not been made yet.

Answer: H
 A rejected claim is a claim that has been denied by the insurance company.

Question 9

For the following questions, refer to the CMS-1500 claim form illustrated in Figure 7-3 of the text.
-Where were the services provided to this patient?

Accepted Answer

The answer of For the following questions, refer to the...

Question 10

For the following questions, refer to the CMS-1500 claim form illustrated in Figure 7-3 of the text.
-What is the procedural code that was submitted on this claim form, describing the services provided to this patient?

Accepted Answer

The answer of For the following questions, refer to the...

Question 11

Match the reason that the insurance claim was rejected with the possible solution to the problem.

-The insurance claim was submitted to the secondary instead of the primary insurer.
A)Proofread numbers carefully from source documents.
B)Check for Sr., Jr., correct birth date, and verify the insured.
C)Refer to an updated diagnostic codebook and review the patient record.
D)Verify with the patient's medical record that all dates of service are listed and accurate.
E)Verify that the place of service is correct for the submitted procedure code(s) and fill in correct service code.
F)Refer to the current procedure codebooks and verify the coding system used by the insurance company.
G)Verify and submit valid modifiers with the correct procedure codes for which they are valid.
H)Total all charges on each claim, recheck the math, and verify amounts with the patient account.
I)Obtain data from patient during the first office visit on which company is the primary insurer.
J)Submit all attachments with patient's name and insurance identification number.

Accepted Answer

Submitting a claim to the wrong insurer (secondary instead of primary) can be avoided by obtaining accurate insurance information from the patient at the first office visit, including which company is the primary insurer.

Question 12

For the following questions, refer to the CMS-1500 claim form illustrated in Figure 7-3 of the text.
-What is the treating physician's NPI number?

Accepted Answer

The answer of For the following questions, refer to the...

Question 13

For the following questions, refer to the CMS-1500 claim form illustrated in Figure 7-3 of the text.
-What is the date that the symptoms first presented for the condition treated?

Accepted Answer

The answer of For the following questions, refer to the...

Question 14

Match the type of insurance claim with the correct description.

-An insurance claim that is submitted via a dial-up modem or direct data entry.
A)Clean claim
B)Dirty claim
C)Electronic claim
D)Incomplete claim
E)Invalid claim
F)Paper claim
G)Pending claim
H)Rejected claim

Accepted Answer

An electronic claim is submitted via a dial-up modem or direct data entry.

Answer: A
 A clean claim is a submitted claim with no errors or missing information.

Answer: B
 A dirty claim is a submitted claim with errors or missing information.

Answer: F
 A paper claim is a claim submitted on paper.

Answer: D
 An incomplete claim is a submitted claim with missing information.

Answer: E
 An invalid claim has incorrect information and cannot be processed.

Answer: G
 A pending claim is a claim that is being reviewed and not yet decided on.

Answer: H
 A rejected claim is a claim that was submitted with errors and cannot be processed.

Question 15

Match the type of insurance claim with the correct description.

-A Medicare claim that contains complete, necessary information but is illogical or incorrect.
A)Clean claim
B)Dirty claim
C)Electronic claim
D)Incomplete claim
E)Invalid claim
F)Paper claim
G)Pending claim
H)Rejected claim

Accepted Answer

An invalid claim is a Medicare claim that contains illogical or incorrect information, making it impossible to process.

Question 16

Match the reason that the insurance claim was rejected with the possible solution to the problem.

-Incorrect modifier.
A)Proofread numbers carefully from source documents.
B)Check for Sr., Jr., correct birth date, and verify the insured.
C)Refer to an updated diagnostic codebook and review the patient record.
D)Verify with the patient's medical record that all dates of service are listed and accurate.
E)Verify that the place of service is correct for the submitted procedure code(s) and fill in correct service code.
F)Refer to the current procedure codebooks and verify the coding system used by the insurance company.
G)Verify and submit valid modifiers with the correct procedure codes for which they are valid.
H)Total all charges on each claim, recheck the math, and verify amounts with the patient account.
I)Obtain data from patient during the first office visit on which company is the primary insurer.
J)Submit all attachments with patient's name and insurance identification number.

Accepted Answer

Incorrect modifiers can lead to claim rejections because they provide additional information about the procedure performed and are crucial for the insurance company to process the claim correctly. Verifying and submitting valid modifiers with the correct procedure codes ensures that the claim accurately reflects the services provided.

Question 17

Match the type of insurance claim with the correct description.

-An insurance claim that is submitted with errors.
A)Clean claim
B)Dirty claim
C)Electronic claim
D)Incomplete claim
E)Invalid claim
F)Paper claim
G)Pending claim
H)Rejected claim

Accepted Answer

A dirty claim is a claim that is submitted with errors, such as missing information or incorrect coding.

Answer: A 
 A clean claim is a claim that is free of errors, complete, and accurately coded.

Answer: C 
 An electronic claim is a claim that is submitted electronically, often through a practice management system or clearinghouse.

Answer: D 
 An incomplete claim is a claim that is missing required information or documentation.

Answer: E 
 An invalid claim is a claim that does not meet the insurance policy requirements or is not covered by the policy.

Answer: F 
 A paper claim is a claim that is submitted on paper and mailed or faxed to the insurance company.

Answer: G 
 A pending claim is a claim that is being reviewed by the insurance company but has not yet been finalized or paid.

Answer: H 
 A rejected claim is a claim that has been reviewed by the insurance company and determined to be ineligible for payment.

Question 18

For the following questions, refer to the CMS-1500 claim form illustrated in Figure 7-3 of the text.
-What is the diagnosis code that was submitted on this claim form, describing the condition the patient was treated for?

Accepted Answer

The answer of For the following questions, refer to the...

Question 19

For the following questions, refer to the CMS-1500 claim form illustrated in Figure 7-3 of the text.
-Who is the physician who treated this patient?

Accepted Answer

The answer of For the following questions, refer to the...

Question 20

Match the reason that the insurance claim was rejected with the possible solution to the problem.

-The patient's insurance number is incorrect.
A)Proofread numbers carefully from source documents.
B)Check for Sr., Jr., correct birth date, and verify the insured.
C)Refer to an updated diagnostic codebook and review the patient record.
D)Verify with the patient's medical record that all dates of service are listed and accurate.
E)Verify that the place of service is correct for the submitted procedure code(s) and fill in correct service code.
F)Refer to the current procedure codebooks and verify the coding system used by the insurance company.
G)Verify and submit valid modifiers with the correct procedure codes for which they are valid.
H)Total all charges on each claim, recheck the math, and verify amounts with the patient account.
I)Obtain data from patient during the first office visit on which company is the primary insurer.
J)Submit all attachments with patient's name and insurance identification number.

Accepted Answer

Proofreading numbers carefully from source documents can help ensure that the patient's insurance number is entered correctly, preventing claims from being rejected due to incorrect insurance numbers.

Quiz 7: The Paper Claim: Cms-1500 02-12

Match the reason that the insurance claim was rejected with the possible solution to the problem. -Patient's name and insured's name are entered as the same when the patient is a dependent.

Match the type of insurance claim with the correct description. -An insurance claim that is submitted on paper, including optically scanned claims.

Match the type of insurance claim with the correct description. -An insurance claim held in suspense due to review or other reason.

Match the type of insurance claim with the correct description. -An insurance claim that requires investigation and needs further clarification.

Match the type of insurance claim with the correct description. -A Medicare claim that is missing required information.

Match the reason that the insurance claim was rejected with the possible solution to the problem. -Operative report is missing from the insurance claim.

Match the reason that the insurance claim was rejected with the possible solution to the problem. -Missing place of service code.

Match the type of insurance claim with the correct description. -An insurance claim that is submitted within the program or policy time limit and correctly completed.

For the following questions, refer to the CMS-1500 claim form illustrated in Figure 7-3 of the text. -Where were the services provided to this patient?

For the following questions, refer to the CMS-1500 claim form illustrated in Figure 7-3 of the text. -What is the procedural code that was submitted on this claim form, describing the services provided to this patient?

Match the reason that the insurance claim was rejected with the possible solution to the problem. -The insurance claim was submitted to the secondary instead of the primary insurer.

For the following questions, refer to the CMS-1500 claim form illustrated in Figure 7-3 of the text. -What is the treating physician's NPI number?

For the following questions, refer to the CMS-1500 claim form illustrated in Figure 7-3 of the text. -What is the date that the symptoms first presented for the condition treated?

Match the type of insurance claim with the correct description. -An insurance claim that is submitted via a dial-up modem or direct data entry.

Match the type of insurance claim with the correct description. -A Medicare claim that contains complete, necessary information but is illogical or incorrect.

Match the reason that the insurance claim was rejected with the possible solution to the problem. -Incorrect modifier.

Match the type of insurance claim with the correct description. -An insurance claim that is submitted with errors.

For the following questions, refer to the CMS-1500 claim form illustrated in Figure 7-3 of the text. -What is the diagnosis code that was submitted on this claim form, describing the condition the patient was treated for?

For the following questions, refer to the CMS-1500 claim form illustrated in Figure 7-3 of the text. -Who is the physician who treated this patient?

Match the reason that the insurance claim was rejected with the possible solution to the problem. -The patient's insurance number is incorrect.