question

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 Human Health 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 Benifits

question

ePHI

answer

electronic Protected Health Information

question

ERA

answer

Electronic Remittance Advice

question

HPID

answer

Health Plan Identifier

question

IRS

answer

Internal Revenue

question

NDC

answer

National Drug Code

question

NFS

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

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

answer

Electronic Data Interchange

question

2. 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

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

answer

Two weeks or less

question

4. Medical practices that do not use the services of clearinghouses submit claims through a ___ to the insurance company.

answer

Carrier Direct/Direct Links

question

List Benefits of using Health Insurance Portability and Accountability Act standard transaction code sets.

answer

a. Fast eligibility evaluations; reduced time in claim life cycles b. Reduction in claim preparation c. Fewer claim rejections d. Cost-effective method through loss prevention e. Fewer delays in processing and quicker response f. Reduction in office expenses

question

6. 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

No

question

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

answer

No

question

8. Name the standard code sets used for the following:

answer

a. Physician services - CPT b. Disease and injuries - ICD-10 c. Pharmaceuticals and biologics - National Drug Code

question

10. The family practice taxonomy code is

answer

207Q0000X

question

11. The American National Standards Institute formed the ___ which developed the electronic data exchange standards.

answer

ASCX12N

question

12. Name the levels of data collected to construct and submit and electronic claim.

answer

a. High-level info b. Claim-level info c. Specialty claim-level info d. Service line-level info e. Specialty service line-level info f. Other info

question

13.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

14. The Claim Attachments Standards have not yet been adopted; however, the health insurance specialist should prepare to be compliant with the requirements as of

answer

January 1, 2016

question

15. 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

16. The most important function of a practice system is

answer

Accounts Receivable

question

17. To look for and correct all errors before the health claims is transmitted to the insurance carrier, you

answer

Print and insurance worksheet or perform a front-end audit or scrubber

question

18. Much of the patient and insurance information required to complete the CMS-1500 form can be found on the ___ that is used to post charges.

answer

Encounter form

question

19. Add-ons software to a practice management system that can reduce the time it takes to build or review a claim before batching is known as a/an

answer

Encoder

question

20. Software that is used in a network that serves a group od users working on a related project, allowing access to the same data, is called a/an

answer

Grouper

question

21. Many insurance companies, such as Medicare, provide instant access to information about pending claims through online

answer

Real time

question

22. An electronic finds transfer agreement may allow for health plans to ___ overpayments from a provider's bank account.

answer

Recoup

question

23. The electronic remittance advice was previously referred to as a/an

answer

Explanation of Medicare Benefits

question

24. 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

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

answer

Test files

question

26. Under HIPAA transaction standard Accredited Standards Committee X12 Version 5010 a ___ digit ZIP code is required report service facility locations.

answer

Nine

question

27. The____ is an electronic tool that enables organizations to file a complaint against a noncompliant covered entity that is negatively affecting the efficient processing of claims.

answer

Administrative Simplification Enforcement tool

question

28. Access controls allows organizations to create ___ for each job category that will restrict access to certain data.

answer

Limitations

question

29. Under HIPAA, ___ efforts must be made to limit the use and disclosure of protected health information.

answer

Reasonable

question

30. Electronic claims are submitted by means of

answer

Electronic data interchange

question

31. Today most claims are submitted by means of

answer

EDI

question

32. The online error-edit process allows providers to

answer

Correct claim errors before transmission of the claim

question

33. Under HIPAA, data elements that are used uniformly to document why patients are seen and what is done to them during their encounter are known as

answer

Medical code sets

question

34. The standard transaction that replaces the paper CMS-1500 claim form and more than 400 versions of the electronic NFS is called the

answer

837P

question

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

answer

Version 6020

question

36. The standard unique number that will be assigned to identify individual health plans under the Affordable Care Act is referred to as a/an

answer

Health plan identifier

question

37. Uniform patient identifiers

answer

Are not yet required, and the proposal is on hold for implementation of the standard.

question

38. The 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

39. An authorization and assignment of benefits signature for a patient who was treated in the hospital but has never been to the provider's office

answer

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

question

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

answer

EFT

question

41. An electronic Medicare remittance advice that takes the place od a paper Medicare explanation of benefits is referred to as

answer

ANSI 835

question

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

answer

direct data entry

question

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

answer

transaction transmission summary

question

44. The HIPAA transaction standard ASC X12 Version 5010 requires that anesthesia services be reported

answer

per minute

question

45. Which section of the HIPAA Security Rule recommends unique \"usernames\" to log on to any computer with access to PHI?

answer

Technical safeguards

question

46. Which section of the HIPAA Security Rule recommends use of screensavers that will activate after 1-60 minutes of inactivity.

answer

Physical safeguards

question

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

answer

Once a week

question

48. An acceptable method for ensuring that electronic PHI cannot be recovered from a hard drive that is being disposed of is by

answer

Insineration

question

49. Like paper claims, electronic claims require the performing physician's signature

answer

False

question

50. Claims can be submitted to various insurance payers in a single-batch electronic transmission.

answer

True

question

51. Under HIPAA, insurance payers can require health care providers to use the payer's own version of local code sets.

answer

False

question

52. As International Classification of Disease and Current Procedural Terminology codes are deleted and become obsolete, they should immediately be removed from the practice's computer system.

answer

False

question

53. HIPAA has brought forth electronic formats for determination of eligibility for a health insurance plan.

answer

True

question

54. HIPAA electronic standards transactions are identified by four-digit number that precedes \"ASC X12.\"

answer

False

question

55. Implementation of ICD-10 resulted in the upgrade to HIPAA transaction standard ASC X12 Version 6020.

answer

False

question

56. HIPAA requires that the NPI number be used to identify employers rather than inputting the actual name of the company when submitted claims.

answer

False

question

57. HIPAA limits how computer system may transmit data and formats for storage of data.

answer

False

question

58. A paper claim remittance advice is generated by Medicare when using ANSI X12 Version 5010.

answer

False

question

59. HIPAA transaction standards ASC X12 Version 5010 allows employer identification numbers to be used to report as a primary identifier.

answer

False

question

60. When transmitting electronic claims, inaccuracies that violate the HIPAA standard transaction format are known as syntax error.

answer

True

question

61. An organization may file a complaint online against someone whose actions affect the ability of a transaction to be accepted or efficiently processed by using the Administration Simplification Enforcement Tool.

answer

True

question

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

answer

False

CHP 8 The Electronic Claim

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