CPB CHPATER 08: CMS 1500 AND UB-04 QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS)
ALREADY GRADED A+
When reporting line item services on multiple page CMS-1500 claims,
which statement is TRUE?
a. The listed diagnosis can change from page to page.
b. Only the diagnosis code(s) reported on the first page may be used and
must be repeated on subsequent pages.
c. More than 12 diagnoses can be reported on a two-page claim.
d. Services related to the additional diagnoses can be on the same claim
Ans✓✓✓b. Only the diagnosis code(s) reported on the first page may be
used and must be repeated on subsequent pages.
When entering the patient's name on the CMS-1500 claim form, what
punctuation should be used?
a. Period c. Space
b. Comma d. Parentheses Ans✓✓✓b. Comma
What is the correct format to enter the date of birth on a paper CMS-
1500 claim form?
a. YY/MM/DD c. MM/DD/CCYY
b. MM/DD/YY d. DD/MM/CCYY Ans✓✓✓d. DD/MM/CCYY
When entering an address which of the following is correct?
a. 101 N. Main Street
, b. 123 No. Main St.
c. 123 N, Main Street
d. 123 North Main Street Ans✓✓✓d. 123 North Main Street
Item 24D on the CMS-1500 claim form is used to report procedures,
services, or supplies. How many modifiers can be added to Item 24D?
a. 1 c. 3
b. 2 d. 4 Ans✓✓✓d. 4
What does accepting an assignment by a provider mean?
a. The patient is not responsible for any charges.
b. The provider accepts a contractual write-off of the difference between
the charged amount and the allowed amount.
c. The provider can bill whatever he determines to be his fee schedule.
d. The provider can bill 115% of the allowed amount Ans✓✓✓b. The
provider accepts a contractual write-off of the difference between the
charged amount and the allowed amount.
What is the UB-04 claim form also called?
a. CMS-1500
b. CMS-1540
c. CMS-1450
d. CMS-5010 Ans✓✓✓c. CMS-1450
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS)
ALREADY GRADED A+
When reporting line item services on multiple page CMS-1500 claims,
which statement is TRUE?
a. The listed diagnosis can change from page to page.
b. Only the diagnosis code(s) reported on the first page may be used and
must be repeated on subsequent pages.
c. More than 12 diagnoses can be reported on a two-page claim.
d. Services related to the additional diagnoses can be on the same claim
Ans✓✓✓b. Only the diagnosis code(s) reported on the first page may be
used and must be repeated on subsequent pages.
When entering the patient's name on the CMS-1500 claim form, what
punctuation should be used?
a. Period c. Space
b. Comma d. Parentheses Ans✓✓✓b. Comma
What is the correct format to enter the date of birth on a paper CMS-
1500 claim form?
a. YY/MM/DD c. MM/DD/CCYY
b. MM/DD/YY d. DD/MM/CCYY Ans✓✓✓d. DD/MM/CCYY
When entering an address which of the following is correct?
a. 101 N. Main Street
, b. 123 No. Main St.
c. 123 N, Main Street
d. 123 North Main Street Ans✓✓✓d. 123 North Main Street
Item 24D on the CMS-1500 claim form is used to report procedures,
services, or supplies. How many modifiers can be added to Item 24D?
a. 1 c. 3
b. 2 d. 4 Ans✓✓✓d. 4
What does accepting an assignment by a provider mean?
a. The patient is not responsible for any charges.
b. The provider accepts a contractual write-off of the difference between
the charged amount and the allowed amount.
c. The provider can bill whatever he determines to be his fee schedule.
d. The provider can bill 115% of the allowed amount Ans✓✓✓b. The
provider accepts a contractual write-off of the difference between the
charged amount and the allowed amount.
What is the UB-04 claim form also called?
a. CMS-1500
b. CMS-1540
c. CMS-1450
d. CMS-5010 Ans✓✓✓c. CMS-1450
