question

Accredited Standards Committee X12

answer

The United States standards body formed by the American National Standards Institute (ANSI) for cross-industry development, maintenance, and publication of electronic data exchange standards.

question

Accredited standards Committee X12 Version 5010

answer

System developed by the American National Standards Institute that meets HIPAA standards for the transmission of either ICD-9 or ICD-10 diagnostic code data.

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application service provider

answer

A practice management system available over the internet in which data are housed on the server of the ASP, but the accounts are managed by the health care provider's staff.

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back up

answer

A duplicate data file, such as tape, CD-ROM, disk, or zip disk, used to record data; it may be used to complete or redo the operation if the primary equipment fails.

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batch

answer

A group claims for different patients from one office submitted in one computer transmission.

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business associated agreement

answer

Contract between the provider and a clearinghouse that submits the electronic claims on behalf of the provider.

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cable modem

answer

A modem used to connect a computer to a cable television system that offers online services.

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claim attachments

answer

Documents that contain information, hard copy or electronic, related to a completed insurance claim that assists in validating the medical necessity or explains the medical service or procedure for payment (e.g., operative report, discharge summary, invoice).

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clearinghouse

answer

a service company that recieves electronic or paper claims from the provider, checks and prepares them for processing, and transmits them in HIPAA-complaint format to the correct carriers

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code sets

answer

Any set of codes with their descriptions used to encode data elements, such as tables of terms, medical concepts, medical diagnostic codes, or medical procedure codes.

question

covered entity

answer

same as definition in Chapter 2

question

data elements

answer

Medical code sets used uniformly to document why patients are seen (diagnosis, ICD-9-CM) and what is done to them during their encounter (procedure, CPT-4, HCPCS).

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digital subscriber line

answer

A high-speed connection through a telephone line jack and usually a means of accessing the Internet.

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direct data entry

answer

Keying claim information directly into the payer system by accessing over modem dial-up or DSL. This is a technology to directly enter the information into the payer system via the access whether it is dial-up or DSL.

question

electronic data interchange

answer

The process by which understandable data items are sent back and forth via computer linkages between two or more entities that function alternatively as sender and receiver.

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electronic funds transfer

answer

A paperless computerized system enabling funds to be debited, credited, or transferred, eliminating the need for personal handling of checks.

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electronic remittance advice

answer

An online transaction about the status of a claim.

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clearing house

answer

Software that receives insurance claims from the providers; performs, edits and sends them to the insurance carriers.

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encoder

answer

An add-on software program to practice management systems that can reduce the time it takes to build or review insurance claims before batch transmission to the carrier.

question

National Standard Format

answer

The name of the standardization of data to reduce paper and have more accurate information and efficient organization.

question

HIPAA Transaction and Code Sets Rule

answer

This regulation under Health Insurance Portability and Accountability Act (HIPAA) defines the standardized methods for transmitting electronic health information. The TCS process includes any set of HIPAA-approved codes with their descriptions used to encode data elements, such as tables of terms, medical concepts,medical diagnostic codes, or medical procedure codes. TCS regulations were implemented to streamline electronic data interchange.

question

password

answer

A combination of letters and numbers that each individual is assigned to access computer data.

question

real time

answer

Online interactive communication between two computer systems allowing instant transfer of information.

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standard transactions

answer

The electric files in which medical data are compiled to produce a specific format.

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T-1

answer

A T-carrier channel that can transmit voice or data channels quickly.

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taxonomy codes

answer

Numeric and alpha provider specialty codes that are assigned and classify each health care provider when transmitting electronic insurance claims.

question

trading partner

answer

same as definition for Business associate in Chapter 2

question

encryption

answer

To assign a code to represent data. This is done for security purposes.

question

trading partner agreement

answer

Contract between the provider and a clearinghouse that submits the electronic claims on be half of the provider.

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ANSI

answer

American National Standards Institute

question

ASC X12

answer

Accredited Standards Committee X12

question

ASET

answer

administrative simplification enforcement tool

question

ASP

answer

application service provider

question

ATM

answer

automated teller machine

question

DDE

answer

direct data entry

question

DHHS

answer

Department of Health and Human Services

question

DSL

answer

Digital Subscriber Line

question

EDI

answer

electronic data interchange

question

EFT

answer

electronic funds transfer

question

EHR

answer

electronic health record

question

EMC

answer

electronic medical claim

question

EOMB

answer

explanation of Medicare benefits

question

ePHI

answer

electronic protected health information

question

ERA

answer

electronic remittance advice

question

HPID

answer

Health Plan Identifier

question

IRS

answer

Internal Revenue Service

question

MTS

answer

Medicare Transaction System

question

NDC

answer

National Drug Code

question

NSF

answer

National Standard Format

question

PMS

answer

practice management software

question

TCS Rule

answer

HIPAA Transaction and Code Set Rule

question

UPS

answer

Uninterruptible Power Source

question

Exchange of data in a standardized format through computer systems is a technology known as..

answer

Electronic Data Interchange (EDI)

question

The act of converting computerized data into a code so that unauthorized users are unable to read it is a security system known as....

answer

Encryption

question

Payment to the provider of service of an electronically submitted insurance claim may be received in approximately...

answer

Two Weeks or Less

question

Medical Practices that do not use the services of clearinghouses submit claims through a ____to the insurance company...

answer

Carrier-Direct/Direct Links

question

The benefits of using HIPAA standard transaction and code set

answer

A).Translations of various formats to the HIPAA-complaint standard format B).Reduction in time of claims preparation C).Fewer Claim Rejections D).Cost-Effective method through loss prevention' E).Fewer delays in processing and quicker response time F).More accurate coding with claims edits G).Consistent Reimbursement

question

Dr. Morgan has 10 or more full-time employees and submits insurance claims for his Medicare patients. Is his medical practice subject to the HIPAA transaction rules?

answer

Yes-Compliance is Required

question

Dr. Maria Montez does not submit insurance claims electronically and has five full-time employees. Is she required to abide by HIPAA transaction rules?

answer

It is not required to comply

question

Standard Code Sets used for the following....

answer

)( Physician Services)-(CPT), Current Procedural Terminology (Diseases and Injuries)-International Classification of Diseases, Ninth Revision, Clinical Modifications, Volumes 1 and 2 (ICD-9-CM) (Pharmaceuticals and Biologicals)-National Drug Code (NDC)

question

The staff at College clinic submits professional health care claims for each of their providers and must use the industry standard electronic format called_______________ to submit them electronically

answer

ASC X12N 837P

question

The billing department at college clinic must use the industry standard electronic format called ___________ to transmit health care claims electronically

answer

ASC X12N 837I

question

The Medicare fiscal intermediary (insurance carrier) uses the industry standard electronic format called____to transmit payment information to the college clinic and college hospital.

answer

ASC X12N 835

question

It has been 3 weeks since Gordon Marshall's health care claim was submitted to the XYZ insurance company and you wish to inquire about the claim.The industry standard electronic format that must be used to transmit this inquiry is called_________

answer

ASC X12N 276/277

question

Dr.Practons insurance billing specialist must use the industry standard electronic format called __________to obtain information about beatrice garcia's health policy benefits and coverage from the insurance plan.

answer

ASC X12N 270/271

question

The family practice taxonomy code is..

answer

207q0000x

question

The American National Standards Institute formed the___which developed the electronic data exchange standards.

answer

ASC X12N

question

Refer to table 8-4 in the handbook to name the levels of data collected to construct and submit a electronic form

answer

High-level information Claim-level information Specialty claim-level information Service line-level information Specialty service line-level information Other information

question

HIPAA electronic standards for claim submission were upgraded to version ________ and all providers,payers, and clearinghouses were required to use it effective January 1, 2012

answer

5010

question

The claims attachment standards have not yet been adopted;however the health insurance specialist should prepare for the final rule that is expected to be published no later than __________

answer

January 1, 2014

question

The _______ is an all numeric 10-character number assigned to each provider and required for all transactions with health plans effective May 23, 2007

answer

NPI

question

The most important function of a practice management system is _________

answer

accounts receivable

question

To look for and correct all errors before the health claim is transmitted to the insurance carrier,you may print an insurance billing worksheet or perform a front-end audit or

answer

scrubber

question

much of the patient and insurance information required to complete the cms-1500 form can be found on the ___________ form that is used to post charges.

answer

encounter

question

Add on software to a practice management system that can reduced the time it takes to build or review a claim before batching is known as a / an

answer

encoder

question

Software that is used in a network that serves a group of users working on a related project allowing access to the same data is a /an

answer

grouper

question

Many insurance companies, such as Medicare, provide instant access to information about pending claims though online _______________

answer

ERA-electronic remittance advice

question

An electronics funds transfer agreement may allow for health plans to ___________ overpayments from a provider's bank account.

answer

recoup

question

The medicare electronic remittance advice was previously referred as a/an _________________________

answer

EOMB-explanation of medicare benefits

question

On completion of a signed agreement and approval of enrollment with a third party payer for electronic claims submission, the provider will be assigned a ________________________ number.

answer

submitter

question

When computer software is upgraded, the physician must submit a batch of ___________________ to the insurance carrier to determine if claims can be transmitted successfully.

answer

test files

question

Under HIPAA transaction standard ASC X12 version 5010,a _____________ digit zip code is required to report service facility locations.

answer

nine

question

The ________________________________ is a electronic tool that enables organizations to file a complaint against a noncompliant covered entity that is negatively impacting the efficient processing of claims.

answer

ASET-ADMINISTRATIVE SIMPLIFICATION ENFORCEMENT TOOL

question

Access controls allow organizations to create _____________ for each job category that will restrict access to certain data.

answer

password

question

Under HIPAA, ________________ efforts must be made to limit the use and disclosure of PHI.

answer

reasonable

question

Electronic claims are submitted by means of

answer

EDI

question

Today most claims are submitted by means of

answer

EDI

question

The online error process allows providers to

answer

correct claim errors prior to transmission of the claim

question

Under HIPAA, data elements that are use uniformly to be documented why patients are seen (diagnosis) and what is done to them during their encounter(procedure) are known as

answer

medical code sets

question

The standard transaction that replaces the paper cms-1500 (02-1200) claim form and more than 400 versions of the electronic national standard format is called the

answer

837P

question

The next version of the electronic claims submission that will be proposed for consideration once lessons are learned from implementation of version 5010 will be

answer

version 6020

question

A standard unique number that will be assigned to identify individual health plans under the affordable care act is referred to as an

answer

HPID

question

Uniform patient identifiers

answer

were required on all claims effective may 23 2007

question

Encounter forms should be reviewed annually for changes that may have been made to

answer

diagnosis codes procedure codes HCPCS codes

question

A technique for entry of data which can save time and keystrokes by recording commands into memory is referred to as use of

answer

macros

question

An authorization and assignment of health benefits signature for a patient who was treated in the hospital but has never been to the providers office

answer

is not required;the authorization obtained by the hospital applies to that provider's claim filing.

question

A paperless computerized system that enables payments to be transferred automatically to a physician's bank account by a third party payer may be done via

answer

EFT-electronic funds transfer

question

An electronic Medicare remittance advice that takes the place of a paper medicare explanation of benefits (EOB) is referred to as

answer

ANSI 835

question

A method for submitting claims electronically by keying information into the payer system for processing is accomplished through use of

answer

direct data entry-DDE

question

A report that is generated by a payer and sent to the provider to show how many claims were received as electronic claims and how many were automatically rejected and will not be processed is called an

answer

transaction transmission summary

question

The HIPAA transaction standard ASC X12 version 5010 requires that anesthesia services be reported

answer

per minute

question

Which section of the HIPAA security rule recommends unique usernames and passwords to log on to any computer with access to PHI?

answer

technical safeguards

question

Which section of the HIPAA security rule recommends use of screensavers that will activate 1 to 60 minutes of inactivity

answer

physical safeguards

question

Verification of successful backups by comparing original records with copied records should be performed

answer

once a week

question

An acceptable method for ensuring that ePHI cannot be recovered from a hard drive that is being disposed of is by

answer

deletion of files formatting hard drives incineration

question

Like paper claims electronic claims require the performing physicians signature

answer

False

question

Claims must be submitted to various insurance payers in a single batch electronic transmission

answer

True

question

under hipaa insurance payers can require health care providers to use the payers own version of local code sets

answer

false

question

as icd and cpt codes are deleted and become obsolete they should immediately be removed from the practices computer system

answer

false

question

hipaa has brought forth electronic formats for determination of eligibility for a health insurance plan

answer

true

question

hipaa's electronic standard transactions are identified by a four digit number that proceeds asc x12n

answer

false

question

implementation of icd-10 resulted in a upgrade to hipaa transaction standard asc x12 version 6020

answer

false

question

hipaa requires that the npi number be used to identify employers rather than inputting the actual name of the company when submitting claims

answer

true

question

hipaa limits how computer systems may transmit data and formats for storage of data

answer

true

question

a paper remittance advice is generated by medicare when using ansi 835 version 5010

answer

true

question

hipaa transaction standard asc x12 version 5010 allows employers identification numbers to be used to report as a primary identifier

answer

false

question

when transmitting electronic claims inaccuracies that violate the hipaa standard transaction format are known as syntax errors

answer

true

question

an organization may file a complaint online against someone whose actions impact the ability of a transaction to be accepted or efficiently processed by using the administrative simplification enforcement tool (ASET)

answer

true

question

incidental uses and disclosures of protected health information(PHI) are permissible under hipaa when reasonable safeguards have been used to prevent inappropriate revelation of phi

answer

true

question

deleting files or formatting the hard drive is sufficient to keep electronic protected health information from being accessed

answer

false

Chapter 8 The Electronic Claim

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