question

What organization determines the content of both HIPAA 837 and CMS-1500 claims?

answer

NUCC

question

The electronic transmission of claims is not required by law if a practice never sends any kind of electronic healthcare transactions, and has less than __________ full-time or equivalent employees.

answer

ten

question

A data element that HIPAA mandates reporting under certain conditions is called a(n):

answer

situational data element

question

When the patient and insured are not the same person, what type of code is required to indicate this fact?

answer

individual relationship code

question

What is the terminology used when the provider must supply the data element on every claim?

answer

required data element

question

In which format can claim attachments be sent?

answer

electronic or paper format

question

Name the POS code used to indicate a procedure occurred in an outpatient hospital.

answer

22

question

Name the data element that is required for use on the HIPAA 837P in conjunction with CMS Item Number 30.

answer

this data element is \"NOT USED\"

question

Name the HIPAA transaction for electronic claims that was generated by physicians.

answer

837 P

question

What is recorded in Section 24 of CMS-1500?

answer

procedures performed for a patient

question

Describe the reason for and the process of \"dropping to paper.\"

answer

the practice prints and sends the CMS-1500 paper claim because the payer has not acknowledged receipt of it via electronic transmission

question

What is the payer's responsibility sequence number for the payer of last resort?

answer

T

question

Describe the circumstances under which the last-seen date is not required to be reported on the HIPAA 837 claim.

answer

a claim involves the original date of a primary care physician's services

question

Why has sending paper claims become less common?

answer

the increased use of information technology

question

Explain how a payer will respond to a claim that does not contain an ICD-9 (or -10)-CM code.

answer

the payer will deny the claim

question

In which of these methods of transmitting claims can employees key standard data elements using an Internet-based service?

answer

direct data entry

question

Assume that three providers are indicated for a claim for lab services. A clearinghouse is the billing provider and the physician practice is the pay-to provider. What type of provider is the laboratory?

answer

the rendering provider

question

Identify the claim filing indicator code that is used to indicate that the health plan is Medicaid.

answer

MC

question

Identify the claim filing indicator code that is used to indicate a self-pay patient.

answer

09

question

Identify the person or organization that receives payment.

answer

the pay-to provider

question

When the subscriber and the patient are the same person, what patient data is required on the HIPAA 837?

answer

the patient data is not required if the subscribed and the patient are the same

question

On a HIPAA claim, which of the following is assigned to a particular service being reported?

answer

a line item control number

question

Determine what was not required of PMP vendors when the HIPAA 837 electronic transaction was mandated.

answer

providing updates at no additional cost

question

Identify what is indicated by an individual relationship code.

answer

the patient's relationship to the insured

question

You need to send a claim to a payer who does not accept electronic claims. Identify the claim form you would use to send a paper claim.

answer

CMS-1500 claim

question

How current must the signature on file have been obtained for the release of information to be permissible?

answer

within twelve months

question

Under HIPAA, payers may not.

answer

refuse to accept the standard transactions

question

What choice may be made in Item Number 6 to show that the insured is the patient?

answer

Self

question

How many different types of providers may need to be identified?

answer

four

question

When nonspecific procedure codes such as unlisted CPT codes are used, the claim must contain:

answer

service-line level description of the work or drug/dosage

question

What entity is the destination payer?

answer

the health plan receiving a HIPAA claim

question

Physicians identify their medical specialty by using:

answer

taxonomy codes

question

On a HIPAA claim, determine which of the following is assigned to a claim by the sender.

answer

claim control number and line item number

question

Explain the reason why the five levels of the HIPAA 837 are set up as a hierarchy.

answer

so that when the claim is sent electronically, the only data elements that have to be sent are those that do not repeat previous data.

question

Identify the important step that immediately proceeds claim transmittal.

answer

checking the claim

question

Why has sending paper claims become less common?

answer

the increased use of information technology

question

Explain the purpose of Item Number 10a -10C on the CMS-1500.

answer

to determine liability for the condition

question

Identify the information included in blocks 1 through 13 of the CMS-1500.

answer

information about the patient and the patient's insurance coverage

question

Determine where you would report a service that was performed by an outside laboratory on the CMS-1500.

answer

providing updates at no additional cost

question

Determine which of the following may be a qualifier.

answer

Item Number 20

question

In which of these methods of transmitting claims do providers and payers exchange transactions directly without using a clearinghouse?

answer

direct transmission to the payer

Chapter 07: Terminology

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