CMS-1500 Health Insurance Claim Form Exam Questions and Answers Already Passed
HCFA stands for : - Answers Health Care Financing Administration
The HCFA-1500 paper health insurance form was developed in______ by ________________ : -
Answers 1975; Health Care Financing Administration (HCFA)
The HCFA claim form was developed to be used by providers for what purpose? - Answers
Billing Medicare for outpatient services
HCFA changed its name to what in July of 2001? - Answers Center for Medicare and Medicaid
Services (CMS)
HCFA-1500 claim form was changed to this in July of 2001 : - Answers CMS-1500 Universal
Claim Form
For EVERY patient, the patient's insurance company should be contacted to verify what? -
Answers 1) The patient's eligibility
2) Coverage is in effect
3) Which benefit plan the patient has
The paper CMS-1500 claim form can be submitted via what means? - Answers Mailed; or
scanned & submitted
Medicare & Medicaid claim forms may be submitted electronically using the : - Answers 837P
standardized encrypted format
As of October 16, 2003, HIPAA required all claim forms to be submitted electronically with what
exception? - Answers Claims submitted to smaller companies
Verification of eligibility, coverage, and insurance plan helps the billing specialist with what? -
Answers 1) Faster processing of the patient's services
2) Knowing which expenses the patient is responsible for
3) Assisting in patient education of insurance coverage
Electronic claims can be submitted in three ways. They are? - Answers 1) Direct data entry
2) Dial-up telephone
3) Computer over the internet
What is Direct Data Entry? - Answers Data is electronically transmitted from a provider's
computer system into a health insurer's computer system.
, What is a Clearinghouse? - Answers A centralized, independent facility or entity that processes
claims electronically to various insurance companies after receiving them from the provider.
What does a Clearinghouse do with the claims PRIOR to submitting them to the insurance
companies? - Answers They separate the claims by carrier, scrub the claim checking for errors,
& submit clean claims to the appropriate insurance company for payment.
What does a Clearinghouse do with claims with missing or incorrect information? - Answers
Return it to the provider for correction.
Info found in TOP portion of the CMS-1500? - Answers Patient related info such as their name,
address, date of birth, marital status, gender, insurance info, & possibly employer info if work
related.
Info found in BOTTOM half of the CMS-1500? - Answers Provider's service & billing info, incl
diagnosis & procedure codes, hospitalization dates, NPI & Tax ID numbers, etc.
What's a Signature on File (SOF)? - Answers Signatures which have been obtained in advance
from the provider on the contract with the third party, & from the patient for billing purposes
retained in their medical records.
What does SOF stand for? - Answers Signature on file
Where does SOF get entered for the provider? - Answers Box 31
Where does SOF get entered for the patient? - Answers Boxes 12 & 13
How long must signatures be kept on file AFTER a claim has been submitted? - Answers 72
months
HOW OFTEN must a provider obtain the patient's signature to be on file for their record? -
Answers Once a year
The NPI replaced what two previously used identifiers? - Answers The PIN & the UPIN
What is the NPI used for? - Answers To identify each health care provider & facility for all
transactions & with all health plans.
This 10-digit ID number was required by HIPAA, & assigned by the CMS : - Answers National
Provider Identifier (NPI)
When does the NPI expire? - Answers Never. It's a lifelong number.
Numbers assigned by IRS to employers for purpose of income tax reporting, & also used on
health claims : - Answers EIN (Employer Identification Number )
or TIN (federal Tax Identification Number)
HCFA stands for : - Answers Health Care Financing Administration
The HCFA-1500 paper health insurance form was developed in______ by ________________ : -
Answers 1975; Health Care Financing Administration (HCFA)
The HCFA claim form was developed to be used by providers for what purpose? - Answers
Billing Medicare for outpatient services
HCFA changed its name to what in July of 2001? - Answers Center for Medicare and Medicaid
Services (CMS)
HCFA-1500 claim form was changed to this in July of 2001 : - Answers CMS-1500 Universal
Claim Form
For EVERY patient, the patient's insurance company should be contacted to verify what? -
Answers 1) The patient's eligibility
2) Coverage is in effect
3) Which benefit plan the patient has
The paper CMS-1500 claim form can be submitted via what means? - Answers Mailed; or
scanned & submitted
Medicare & Medicaid claim forms may be submitted electronically using the : - Answers 837P
standardized encrypted format
As of October 16, 2003, HIPAA required all claim forms to be submitted electronically with what
exception? - Answers Claims submitted to smaller companies
Verification of eligibility, coverage, and insurance plan helps the billing specialist with what? -
Answers 1) Faster processing of the patient's services
2) Knowing which expenses the patient is responsible for
3) Assisting in patient education of insurance coverage
Electronic claims can be submitted in three ways. They are? - Answers 1) Direct data entry
2) Dial-up telephone
3) Computer over the internet
What is Direct Data Entry? - Answers Data is electronically transmitted from a provider's
computer system into a health insurer's computer system.
, What is a Clearinghouse? - Answers A centralized, independent facility or entity that processes
claims electronically to various insurance companies after receiving them from the provider.
What does a Clearinghouse do with the claims PRIOR to submitting them to the insurance
companies? - Answers They separate the claims by carrier, scrub the claim checking for errors,
& submit clean claims to the appropriate insurance company for payment.
What does a Clearinghouse do with claims with missing or incorrect information? - Answers
Return it to the provider for correction.
Info found in TOP portion of the CMS-1500? - Answers Patient related info such as their name,
address, date of birth, marital status, gender, insurance info, & possibly employer info if work
related.
Info found in BOTTOM half of the CMS-1500? - Answers Provider's service & billing info, incl
diagnosis & procedure codes, hospitalization dates, NPI & Tax ID numbers, etc.
What's a Signature on File (SOF)? - Answers Signatures which have been obtained in advance
from the provider on the contract with the third party, & from the patient for billing purposes
retained in their medical records.
What does SOF stand for? - Answers Signature on file
Where does SOF get entered for the provider? - Answers Box 31
Where does SOF get entered for the patient? - Answers Boxes 12 & 13
How long must signatures be kept on file AFTER a claim has been submitted? - Answers 72
months
HOW OFTEN must a provider obtain the patient's signature to be on file for their record? -
Answers Once a year
The NPI replaced what two previously used identifiers? - Answers The PIN & the UPIN
What is the NPI used for? - Answers To identify each health care provider & facility for all
transactions & with all health plans.
This 10-digit ID number was required by HIPAA, & assigned by the CMS : - Answers National
Provider Identifier (NPI)
When does the NPI expire? - Answers Never. It's a lifelong number.
Numbers assigned by IRS to employers for purpose of income tax reporting, & also used on
health claims : - Answers EIN (Employer Identification Number )
or TIN (federal Tax Identification Number)
