Which of the following items is where the date(s) of service are documented?
a. 24a
b. 24b
c. 24c
d. 24d
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Q. 2) Which of the following items is where the prior authorization number is recorded?
a. 20
b. 21
c. 22
d. 23
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Q. 3) The information required for the first block on the CMS-1500 is:
a. insured.
b. secondary insurance.
c. patient.
d. illness.
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Q. 4) The diagnosis for the procedure being billed is documented in item:
a. 20.
b. 21.
c. 22.
d. 23.
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Q. 5) When reporting the date of illness, accident, or injury in block 14, a pregnancy is recorded by:
a. the date the first pregnancy test was completed.
b. the date of the confirming pregnancy test.
c. the date of missed menstrual cycle.
d. the date of the patient's last menstrual cycle.
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Q. 6) The authorized signature block is for assignment of benefits and:
a. claim to insurance funding.
b. authorization for release of information.
c. ability to bill insurance.
d. provider of services.
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Q. 7) How many signatures are required in the authorized signature block?
a. 2
b. 3
c. 4
d. 7
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Q. 8) Which of the following is NOT a part of the patient information section?
a. Relationship to insured
b. Name, address
c. Type of insurance
d. Insured's ID number
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Q. 9) Which of the following is NOT a part of the insured information?
a. Patient date of birth
b. Insured's ID number
c. Employment information
d. Insurance plan name
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Q. 10) The term referring to any insurance other than the insurance listed in the patient and insured blocks is:
a. secondary insurance.
b. primary insurance.
c. insurance.
d. addendum.
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