cms hippa

Using online resources presented in this course, what does claim adjustment reason code 1 indicate? A. Copayment Amount B. Duplicate Claim/Service C. Deductible Amount D. Day Outlier Amount

C. Deductible Amount

Select all of the correct answers that apply. All correct answers must be selected to receive credit. Partial credit will not be given. Which of the following transactions have a final HIPAA standard? A. Health plan premium payments B. Enrollment and disenrollment in a health plan C. Request and response for eligibility for a health plan D. Referral certification and authorization E. Health care claim or equivalent encounter information F. Health claim status inquiry and response G. Health care payment and remittance advice H. Coordination of benefits I. First report of injury J. Health care claims attachments

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You work in a physician's office and are following up on a code from a remittance advice. A claim was processed by a health plan and the remittance advice lists M13 as the remark code explaining the way the claim was processed. Using resources provided in this lesson including http://www.wpc-edi.com/reference research what remark code M13 means and choose the best meaning listed below. A. Only one initial visit is covered per specialty per medical group B. Not paid separately when the patient is an inpatient C. Equipment purchases are limited to the first or tenth month of medical necessity D. Missing radiology report

A. Only one initial visit is covered per specialty per medical group

In addition to addressing the security and privacy of health data, HIPAA required the establishment of A. a committee to review the quality of health care provided. B. standards for electronic health care transactions. C. standards for all initial claims to be submitted electronically. D. standards for work flow in health care offices.

A. a committee to review the quality of health care provided

Indicate the current version of HIPAA standards. A. ASC X12N 4010 and 4010A1 B. ASC X12N 5010 and 5010A1

B. ASC X12N 5010 and 5010A1

Using the appropriate job aid (provided in this lesson) and the CMS listserv registration page, indicate which of the options listed below is NOT a CMS listserv. A. CMS-QPU B. CMS-SMU C. CMS-HIPAAPORT-L D. MLNMATTERS-L

B. CMS-SMU

If you are working in a physician's office and file health care claims electronically, what standard format does HIPAA require you to use? A. 271 B. 274 C. 835 D. 837

C. 835

Which of the following is NOT a HIPAA standard? A. 270 B. 274 C. 835 D. 837

C. 835

Under ASCA, which of the following is not an automatic exception to the Medicare electronic claims filing requirement? A. Disruption in electricity or communication connections outside of a provider's control expected to last more than two business days B. Claims for services or supplies furnished outside of the U.S. by non-U.S. providers C. Claims from providers that submit fewer than 20 claims per month on average during a calendar year D. Claims for payment under Medicare demonstration projects

C. Claims from providers that submit fewer than 20 claims per month on average during a calendar year

If you are a provider (other than a retail pharmacy) submitting a health care claim electronically, what standard transaction should you submit to a health plan for reimbursement? A. 270 B. 276 C. 835 D. 837

D. 837

Except for retail pharmacy standards, the current version of HIPAA standards is: A. ASC X12N 005010 B. ASC X12N 4010A1 C. ASC X12N 401000A1 D. ASC X12N 501000

D. ASC X12N 501000

Which of the following electronic transactions does not have a final HIPAA standard yet? A. Claims B. Attachments C. Remittances D. Premiums

D. Premiums

HIPAA required the establishment of ______________. Which of the following is NOT a true statement? A. standards for electronic health care transactions B. national identifiers for providers, health plans, and employers C. health security and privacy standards D. a requirement to conduct Medicare claims transactions electronically

D. a requirement to conduct Medicare claims transactions electronically

All HIPAA standards are developed by Federal government agencies.

false

Each health care plan prepares its own implementation guide.

false

Implementation guides provide further guidance specific to a health plan or payer concerning the use of loops, segments and data elements identified as situational in a companion guide.

false

Medicare is exempt from HIPAA standards.

false

The only applicable requirement of HIPAA regarding health care providers and health care plans is its privacy requirements.

false

A covered entity is a health care provider, health clearinghouse or health plan.

true

Companion guides are the specific technical instructions for implementing each of the adopted standards and contain all of the information needed for implementing a standard

true

HIPAA is an acronym that stands for the Health Insurance Portability and Accountability Act

true

HIPAA standards are developed by various organizations.

true

Medicare companion guides are only published by CMS (Medicare).

true

Medicare contractors may issue companion documents in addition to those issued by CMS.

true

Place of service codes are a HIPAA standardized code set.

true

Remittance Advice Remark Codes are a HIPAA standardized code set.

true