question

true

answer

the exchange of data in a standardized format through computer systems is known as electronic data interchange

question

true

answer

encrypted data often look like gibberish to unauthorized users

question

false

answer

a batch of claims is a group of claims for different facilities that are sent to the same clearing house

question

true

answer

the objective of HIPAA transactions and code set regulations was to standardize code sets, claim forms, and processes used in the health care facilities which would reduce administrative costs

question

false

answer

a disadvantage of electronic claims submission is more time spent processing claims, which requires additional staffing

question

false

answer

any provider who submits claims to Medicare is considered a covered entity

question

true

answer

CPT, ICD-9, and HCPCS codes are referred to as medical code sets and are standardized under HIPAA

question

true

answer

certain data elements are required when submitting a HIPAA standard transaction, whereas other are only necessary in specific situations

question

false

answer

the American Medical Association (AMA) developed the standards for electronic data exchange

question

true

answer

the 837P is the National Standard Format for electronic claims submission by physicians, which replaces the paper CMS-1500 form

question

false

answer

the newest version of electronic claims submission is known as 6020 and was required effective February 1, 2012

question

false

answer

the National Provider Identifier identifies each individual health plan and is required on all claims as of May 23, 2007

question

true

answer

encounter form's procedure and diagnostic codes should be audited annually to determine if code changes have been made and if the form needs to be updated accordingly

question

false

answer

the most important function of a practice management system is coding of claims submission

question

true

answer

for insurance claims to be submitted electronically, a signed agreement by the physician with the carriers involved is necessary

question

true

answer

health care providers must comply with electronic fund transfer rules by January 1, 2014

question

false

answer

electronic remittance advisories are sent to physicians following electronic funds transfer. However, the staff must still manually post payments to each individual patient's account

question

true

answer

practice management systems can be "rented" from practice management systems over the internet

question

false

answer

clearinghouses always charge a flat fee for claim processing

question

false

answer

confidential data should be stored only in the computer's hard drive

question

false

answer

time limits stated in individual health insurance policies about an insurance company's obligation to pay benefits are the same for all insurance companies

question

false

answer

there is a standardization of format for the explanation of benefits document for all private insurance carriers

question

true

answer

the insurance industry is protected by a special exemption from the Federal Trade Commission

question

true

answer

insurance companies are rated according to the number of complaints received about them

question

true

answer

the status of electronic insurance claims may be accessed quickly electronically or telephonically by digital response systems

question

true

answer

inquiries about insurance claims may be in writing or by telephone

question

false

answer

a rejected insurance claim should be corrected and sent for review or appeal

question

false

answer

approximately 50% of individuals pursue appeals on a denied insurance claim

question

true

answer

in the case of a Medicare Part B redetermination, carriers have been instructed to pay an appealed insurance claim if the cost of the hearing process is more than the amount of the claim

question

false

answer

if you have a denied insurance claim, you should change the information and resubmit the claim

question

true

answer

routine use of too many nonspecific diagnostic codes may result in downcoding

question

true

answer

in any type of overpayment situation, always cash the third-party payer's check and write a refund check payable to the originator of the overpayment

question

true

answer

if the provider is notified by a commercial insurance carrier that an overpayment has been made, investigate the refund request

question

true

answer

a level 1 Medicare redetermination (appeal) may be made by telephone, in writing, or by submitting a CMS-20027 form

question

false

answer

a peer review is usually done before the appeal process

question

true

answer

appeal decisions on Medicare unassigned insurance claims are sent to the patient

question

false

answer

the highest level of a Medicare redetermination is with an administrative law judge

IHMO chapter 8;9 true or false – Flashcards

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