question

What does the abbreviation RA stand for?

answer

remittance advice

question

What do primary payers issue to detail how a claim was processed, in order for a secondary claim to be submitted?

answer

remittance advice

question

When is it not necessary to submit a claim to a secondary payer?

answer

when the payer handles COB

question

What does the abbreviation EMC stand for?

answer

electronic media claims

question

If a paper RA is received, what should be sent to the secondary health plan?

answer

both the CMS-1500 and the RA

question

What is another name for the HIPAA claim?

answer

837P claim

question

When in the billing process is an EOB sent to a patient?

answer

after the claim gets paid or denied

question

What is another name for the CMS-1500

answer

paper claim form

question

A claim accepted by a health plan for adjudication is called

answer

clean claim

question

Which association leads the National Uniform Claim Committee (NUCC)?

answer

American Medical Association

question

When are claims prepared for transmission?

answer

after data elements have been posted to the PMP

question

What is the same as a COB transaction?

answer

HIPAA 837

question

What happens when a primary payer forwards the COB transaction?

answer

a message appears on the primary payer's RA

question

How many national crossover agreements do plans that are supplemental to Medicare sign?

answer

one

question

In the direct claims transmission approach, which formatting rules should the provider follow?

answer

EDI

question

What is a responsibility of medical assistants before transmitting claims with Practice Management Programs?

answer

extract and record data elements such as diagnosis, procedures, and charges

question

What does EDI stand for?

answer

electronic data interchange

question

What form should be used to bill a secondary health plan, when a paper RA is received?

answer

CMS-1500

question

What replaced the HCFA-1500

answer

CMS-1500

question

What does HIT stand for?

answer

health information technology

question

When does a primary payer not need to submit a claim to the secondary payer?

answer

when the primary payer handles the COB

question

When sending a claim to a tertiary payer, what needs to be attached?

answer

secondary RA

question

What do the majority of providers use to send and receive data in correct EDI format?

answer

clearinghouses

question

Which types of claims are generally used for reporting physicians' services?

answer

both paper claims and HIPAA claims

question

What must a medical assistant do when preparing claims with PMPs?

answer

record diagnoses, procedures, and charges

question

What type of information does the Provider section of practice management programs contain?

answer

NPI

question

What do some payers offer as an Internet-based service into which employees key the standard data elements?

answer

DDE

question

What is not a major database in PMPs?

answer

next of kin

question

With a few exceptions, the electronic claim is the same as

answer

paper form

question

In the direct transmission approach, providers and payers exchange transactions directly without using what?

answer

clearinghouse

question

What is an RA?

answer

detailed account of how the claim was processed

question

What is considered when the NUCC revises the paper claim?

answer

HIPAA claim

question

What organization provides updates the CMS-1500?

answer

NUCC

question

What is the first task a medical assistant must perform when preparing claims with PMPs?

answer

record patients' insurance and demographic information

question

What does the administrative/billing medical assistant send in to the secondary payer with the claim form?

answer

RA

question

What is the most common method to handle health care claim transmission?

answer

hire clearinghouses

question

What are the financial aspects of an office visit, such as a copayment, called?

answer

transactions

question

What are collections of related facts, such as diagnosis indices, patients of the practice?

answer

databases

question

Billing efficiency is increased by using what kind of software?

answer

Practice Management Programs

question

A_________ is most likely to be sending a claim through a billing service.

answer

billing provider

question

A physician practice that uses a billing service to send its claims is the

answer

pay-to-provider

question

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

answer

line item control number

question

On a HIPAA claim, which is assigned to a claim by the sender?

answer

both claim control number or line item number

question

Which of these is associated with payers?

answer

National Payer ID

question

The provider who performs the procedure on a claim other than the pay-to-provider

answer

rendering provider

question

Assume that three providers are indicated on 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

rendering provider

question

Patient information on a CMS-1500 information includes

answer

all of these: type of insurance, ID number, and address and phone

question

A unit of information on a HIPAA claim is called a data

answer

element

question

The HIPAA-mandated electronic transaction for claims is often called

answer

both the HIPAA claim and the 837P claim

question

The P in 837P stands for

answer

professional

question

The carrier block on the CMS 1500 form is

answer

a section on the CMS-1500 for payer name and address

question

On the CMS-1500, if the patient and insured are the same person, where is the patient's name and address entered?

answer

insured's information INs

question

What type of information might be found on a claim attachment?

answer

both additional form and medical record item

question

The organization or person transmitting the claim to the payer is the

answer

billing provider

question

The organization or person that should received payment is the

answer

pay-to-provider

question

Physician practices often hire other firms to send their claims, such as

answer

both billing services and clearinghouses

question

If a practice sends claims directly to the payer, it is the

answer

both the billing provide and the pay-to-provider

question

The taxonomy codes are one of the nonmedical or nonclinical

answer

administrative code sets

question

What can be used to track payments from a health plan

answer

both the claim control number and the line control number

question

What administrative code is used to identify the type of health plan

answer

claim filing indictor code

question

What code is used to indicate whether a claim is an original, replacement, or voided code

answer

both claim frequency code and claim submission reason code

question

What are examples of data elements

answer

both the patient's first name and the patient's last name

question

Which of the following is not one of the five major sections, or levels, of data elements of a claim

answer

relatives

question

The part of the HIPAA claims contains information about the payer to whom the claim is going to be sent, called the

answer

destination payer

question

A claim control number is assigned by

answer

the medical office

question

The claim frequency code is sometimes known as the

answer

claim submission reason code

question

The claim frequency code for physician practice claims indicates all of the following except

answer

going to be rejected for not

question

All of the financial aspects of office visits, such as charges and payments, are

answer

transactions

question

The abbreviation NUCC stands for

answer

National Uniform Claim Committee

question

The NUCC can be expected to continue to update what form?

answer

CMS-1500 form

question

A code indicating what a number represents is a

answer

qualifier

question

The term service line information describes section 24 of the CMS-1500 claim, which reports

answer

procedures performed for the patient

question

Laboratory services rendered by an independent provider are performed by an

answer

outside laboratory

question

What does a place of service (POS) code describe about a service provided?

answer

location

question

On the CMS-1500 claim, if the patient and the insured are not the same person, which of these is required?

answer

insured's name, patient's relationship to the insured, and insured's address

question

The letters "SOF" on a claim mean

answer

signature on file

question

How many digits are in a taxonomy code?

answer

ten

question

If the claim indicates the patient's signature is on file, this requires

answer

both a current release if applicable and release covers the data on the claim

question

What term does the HIPAA claim use for the insurance policyholder or guarantor?

answer

subscriber

question

On the HIPAA claim, what code is required to specify the patient's relationship to the subscriber when the patient and the subscriber are not the same person?

answer

individual relationship code

question

A unique number assigned by the sender to each service line is a

answer

line item control number

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