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MS 1505 4 177 ASSIGNMENT 11.3-IDENTIFYING CMS-1500 CLAIMS COMPLETION ERRORS Objectives At the conclusion of this assignment, the student should be able to 1. Explain how optical scanning guidelines impact CMS-1500 claims completion 2. Identity CMS-1500 claims completion errors. Overview The CMS-1500 paper claim was designed to accommodate optical scanning of paper claims. This process uses a device (0.9., scanner) to convert printed or handwritten characters into text that can be viewed by an optical character reader (OCR) (a device used for optical character recognition). Entering duts into the computer using this technology greatly increases productivity associated with claims processing because the need to manually enter data from the claim into a computer is cominated. It is also important to ensure that submitted CMS-1500 claims are free of other edits, such as formats required for entering dates codes, and so on E NOTE: When completing this assignment, refer to optical scanning guidelines located in Chapter 11 in your book Instructions 1. The CMS-1500 claims in Figures 11-1 to 11-3 contain optical scanning and other errors 2. Review each claim to identify the optical scanning and other errors. 3. Cirdle each optical scanning and other errors. 2011 One More 178 Chapter 11 CARRER HEALTH INSURANCE CLAIM FORM CD 123456790 TIME CHRIS P. CREAM CREAM, CHRIS,P 1990 ECLAIR LANE OC ANYWHERE NY 12345 OR OSCH FOR OUR 0908 1950 DORURE DACO ORUCE ONDON NEPATE OF NAME AETNA ANNONCENTRANET HEAD OF POWEGO SIGNATURE ON FILE GL SIGNATURE ON FILE 0704YYYY 01 GENTE SO XG AM129 OVH 07 04 YYYY 09212 45 00 3 4 5 11-A 11-1234562 BLOG 00 ON 101 ) 1115555 DONALD L GIVINGS HD 11350 MEDICAL DRIVE ANTWHERE NY 12345 1234567 DONALD L GIVINGS MD MHDOINY NUO PELTORTE FIGURE 11-1 Chris P. Crear CMS-1500 with optical scanning errors. CMS-1500 and Us 04 Cm 179 HEALTH INSURANCE CLAIM FORM CAN COEU CARRER EDGAD TINGAR CH x BRIGHT BRITTANY 42915750 WOT BRITTANY 04 07 1958 8731 NOVELS AVENUE ANYWHERE WARE NY GE 12345 ROHOANG PATIENT AND SURED INFORMATION X DACOM 04 07 1585 RUCE x 1. onenioren HEALTH OPOMBE PRORE SIGNATURE ON FILE O SIGNATURE ON FILE 1031 MYDL 431 DEDE 145909 1021 mm 99212 24 55 2 3 4 5 6 35 00 111234562 ACRO 101 1115555 DONALD L GIVINGS HD 11.350 MEDICAL DRIVE ANTINERE NY 12345 123456789 DONALD L GIVINGS MDMMOOTTYY GO RESENT OR TYPE FIGURE 11-2 Brittany Bright CMS-1500 with optical scanning errors. HEALTH INSURANCE CLAIM FORM CARRIER One 321951456 TE DUNNETT ANTHONY L 70 1990X DUETT ANTHONY 555 MILKY WAY OT ANYWHERE 13 000 12345 NY 411 PATIENT AND SURED INFORMATION x 07 30 1990 CE CONOCE METROPLITAN SIGNATURE ON FILE SIGNATURE 04 01 M 431 DUL SO DRS 1 04 01 WAY 2 99211 ORMATION 350 00 5 3 55 4 5 WYBIROR MPUR 5 6 111234524 DX 350 00 101 1111234 ERIN A HUPER MO 101 MEDIC STREET ANYWHERE NY 12345 ERIN A HELPER MD MMODYTI PLEAST ONE FIGURE 11-3 Anthony Dunnett CMS-1500 with optical scanning errors. CMS 1500 and U-54 a. 3 187 ASSIGNMENT 11.5 - MULTIPLE CHOICE REVIEW 1. The Federal Privacy Act of 1974 prohibits a payer from nothing the provides about payment or rection of unassigned claims or payments sent directly to the patient or a government b. policyholder c. provider 2. Medicare Conditions of Participation (COP) require providers to keep copies of any government inson d. third-party payer claims and copies of all attachments filed by the provider for a period of_years, unless state law specifies a longer period 0.5 0.7 d. 10 3. After comparing batched remittance advice notices with claims submitted, t an error in processing is found leg.. denied claims), which should be done? a. Complete new CMS-1500 claims for any denied claims so that the third-party property processes them b. Discard the batched remittance advice notices and claims because the payer has denied payment c. Mail a copy of the batched remittance advice notices and claims to the provider for reconsideration d. Submit an appeal to the third-party payer for reconsideration of payment for any denied claims. 4. When Block 27 contains an Xin the YES box, the provider agrees to a. accept assignment and collect a copayment from the patient. b. accept assignment and collect deductible copayment coinsurance amounts from the patient. c. collect deductible and coinsurance payments from the patient d. collect deductible/copayment/coinsurance amounts from the policyholder 5. Optical character reader (OCR) guidelines were established when the a. Balanced Budget Act was passed b. CMS-1500 claim was developed. c. HCFA changed to CMS in 2001. d. HIPAA legislation was passed 6. Medicare supplemental plans usually cover which of the following? a all prescribed pharmaceutical medications b. anything that Medicare Part A does not cover c. deductible, copayment, coinsurance amounts d. health insurance premiums, including deducties 7. Which is the correct way to enter the amount of $125.75 on the CMS-1500 claim? c. $125 75 a. $125.75 d. 125 75 b. 125.75 8. A patient's name on the insurance card reads Marin L. Buell. How is this entered on the CMS-1500 claim? MARVIN, BLUE,L a BLUE, MARVIN, L d MARVIN L BLUE b. BLUE, MARVIN, LIH 9. Which is the proper way to report a patient's birth date of June 16, 1957. on the CMS-150 cm? a 06-16-87 b. 06 16 67 c08-18-1967 d 08 16 1987 10. Which is a common error that delays claims processing? a aligning paper-based claims so that data is populated in a propriate fields b. keyboarding accurate patient identification information C. Isting dates of services for procedures/services provided d reporting ICD-10-PCS codes when CPT codes are required robe scared to con 188 Chapter 11 11. Which is the proper format for entering the name of a provider in Block 33 of the CMS-1500 claim? a. Dr. Howard Hurtz b. Dr. Howard Hurtz, M.D. C. Howard Hurtz MD d. Hurtz, Howard MD. 12. Which is issued by CMS to individual providers and health care organizations? a. EIN b. NPI C. PIN d. UPIN 13. If the patient does not sign Block 13 of the CMS-1500 claim, the payer sends reimbursement to the a billing entity c patient. b. facility d. provider 14. When more than one diagnosis reference number is reported on a CMS-1500 claim, the first-listed code is the a condition that has been treated most regularly. b. diagnosis with the highest reimbursement rate. ci illness most likely to require hospital admission d. reason the patient was treated by the provider. 15. What type of data are required by all payers in Block 24B of the CMS-1500 claim? a. date of service b. place of service c. type of service d. units of service - 0 A: 2 2020 WORKBOOK TO ACCOMPANY UNDERSTANDING HEALTH INSURANCE A GUIDE TO BILLING AND REIMBURSEMENT MICHELLE A. GREEN MPS, RHIA, FAHIMA, CPC (1) AAPC CEU APPROVED MS 1505 4 177 ASSIGNMENT 11.3-IDENTIFYING CMS-1500 CLAIMS COMPLETION ERRORS Objectives At the conclusion of this assignment, the student should be able to 1. Explain how optical scanning guidelines impact CMS-1500 claims completion 2. Identity CMS-1500 claims completion errors. Overview The CMS-1500 paper claim was designed to accommodate optical scanning of paper claims. This process uses a device (0.9., scanner) to convert printed or handwritten characters into text that can be viewed by an optical character reader (OCR) (a device used for optical character recognition). Entering duts into the computer using this technology greatly increases productivity associated with claims processing because the need to manually enter data from the claim into a computer is cominated. It is also important to ensure that submitted CMS-1500 claims are free of other edits, such as formats required for entering dates codes, and so on E NOTE: When completing this assignment, refer to optical scanning guidelines located in Chapter 11 in your book Instructions 1. The CMS-1500 claims in Figures 11-1 to 11-3 contain optical scanning and other errors 2. Review each claim to identify the optical scanning and other errors. 3. Cirdle each optical scanning and other errors. 2011 One More 178 Chapter 11 CARRER HEALTH INSURANCE CLAIM FORM CD 123456790 TIME CHRIS P. CREAM CREAM, CHRIS,P 1990 ECLAIR LANE OC ANYWHERE NY 12345 OR OSCH FOR OUR 0908 1950 DORURE DACO ORUCE ONDON NEPATE OF NAME AETNA ANNONCENTRANET HEAD OF POWEGO SIGNATURE ON FILE GL SIGNATURE ON FILE 0704YYYY 01 GENTE SO XG AM129 OVH 07 04 YYYY 09212 45 00 3 4 5 11-A 11-1234562 BLOG 00 ON 101 ) 1115555 DONALD L GIVINGS HD 11350 MEDICAL DRIVE ANTWHERE NY 12345 1234567 DONALD L GIVINGS MD MHDOINY NUO PELTORTE FIGURE 11-1 Chris P. Crear CMS-1500 with optical scanning errors. CMS-1500 and Us 04 Cm 179 HEALTH INSURANCE CLAIM FORM CAN COEU CARRER EDGAD TINGAR CH x BRIGHT BRITTANY 42915750 WOT BRITTANY 04 07 1958 8731 NOVELS AVENUE ANYWHERE WARE NY GE 12345 ROHOANG PATIENT AND SURED INFORMATION X DACOM 04 07 1585 RUCE x 1. onenioren HEALTH OPOMBE PRORE SIGNATURE ON FILE O SIGNATURE ON FILE 1031 MYDL 431 DEDE 145909 1021 mm 99212 24 55 2 3 4 5 6 35 00 111234562 ACRO 101 1115555 DONALD L GIVINGS HD 11.350 MEDICAL DRIVE ANTINERE NY 12345 123456789 DONALD L GIVINGS MDMMOOTTYY GO RESENT OR TYPE FIGURE 11-2 Brittany Bright CMS-1500 with optical scanning errors. HEALTH INSURANCE CLAIM FORM CARRIER One 321951456 TE DUNNETT ANTHONY L 70 1990X DUETT ANTHONY 555 MILKY WAY OT ANYWHERE 13 000 12345 NY 411 PATIENT AND SURED INFORMATION x 07 30 1990 CE CONOCE METROPLITAN SIGNATURE ON FILE SIGNATURE 04 01 M 431 DUL SO DRS 1 04 01 WAY 2 99211 ORMATION 350 00 5 3 55 4 5 WYBIROR MPUR 5 6 111234524 DX 350 00 101 1111234 ERIN A HUPER MO 101 MEDIC STREET ANYWHERE NY 12345 ERIN A HELPER MD MMODYTI PLEAST ONE FIGURE 11-3 Anthony Dunnett CMS-1500 with optical scanning errors. CMS 1500 and U-54 a. 3 187 ASSIGNMENT 11.5 - MULTIPLE CHOICE REVIEW 1. The Federal Privacy Act of 1974 prohibits a payer from nothing the provides about payment or rection of unassigned claims or payments sent directly to the patient or a government b. policyholder c. provider 2. Medicare Conditions of Participation (COP) require providers to keep copies of any government inson d. third-party payer claims and copies of all attachments filed by the provider for a period of_years, unless state law specifies a longer period 0.5 0.7 d. 10 3. After comparing batched remittance advice notices with claims submitted, t an error in processing is found leg.. denied claims), which should be done? a. Complete new CMS-1500 claims for any denied claims so that the third-party property processes them b. Discard the batched remittance advice notices and claims because the payer has denied payment c. Mail a copy of the batched remittance advice notices and claims to the provider for reconsideration d. Submit an appeal to the third-party payer for reconsideration of payment for any denied claims. 4. When Block 27 contains an Xin the YES box, the provider agrees to a. accept assignment and collect a copayment from the patient. b. accept assignment and collect deductible copayment coinsurance amounts from the patient. c. collect deductible and coinsurance payments from the patient d. collect deductible/copayment/coinsurance amounts from the policyholder 5. Optical character reader (OCR) guidelines were established when the a. Balanced Budget Act was passed b. CMS-1500 claim was developed. c. HCFA changed to CMS in 2001. d. HIPAA legislation was passed 6. Medicare supplemental plans usually cover which of the following? a all prescribed pharmaceutical medications b. anything that Medicare Part A does not cover c. deductible, copayment, coinsurance amounts d. health insurance premiums, including deducties 7. Which is the correct way to enter the amount of $125.75 on the CMS-1500 claim? c. $125 75 a. $125.75 d. 125 75 b. 125.75 8. A patient's name on the insurance card reads Marin L. Buell. How is this entered on the CMS-1500 claim? MARVIN, BLUE,L a BLUE, MARVIN, L d MARVIN L BLUE b. BLUE, MARVIN, LIH 9. Which is the proper way to report a patient's birth date of June 16, 1957. on the CMS-150 cm? a 06-16-87 b. 06 16 67 c08-18-1967 d 08 16 1987 10. Which is a common error that delays claims processing? a aligning paper-based claims so that data is populated in a propriate fields b. keyboarding accurate patient identification information C. Isting dates of services for procedures/services provided d reporting ICD-10-PCS codes when CPT codes are required robe scared to con 188 Chapter 11 11. Which is the proper format for entering the name of a provider in Block 33 of the CMS-1500 claim? a. Dr. Howard Hurtz b. Dr. Howard Hurtz, M.D. C. Howard Hurtz MD d. Hurtz, Howard MD. 12. Which is issued by CMS to individual providers and health care organizations? a. EIN b. NPI C. PIN d. UPIN 13. If the patient does not sign Block 13 of the CMS-1500 claim, the payer sends reimbursement to the a billing entity c patient. b. facility d. provider 14. When more than one diagnosis reference number is reported on a CMS-1500 claim, the first-listed code is the a condition that has been treated most regularly. b. diagnosis with the highest reimbursement rate. ci illness most likely to require hospital admission d. reason the patient was treated by the provider. 15. What type of data are required by all payers in Block 24B of the CMS-1500 claim? a. date of service b. place of service c. type of service d. units of service - 0 A: 2 2020 WORKBOOK TO ACCOMPANY UNDERSTANDING HEALTH INSURANCE A GUIDE TO BILLING AND REIMBURSEMENT MICHELLE A. GREEN MPS, RHIA, FAHIMA, CPC (1) AAPC CEU APPROVED