HIT Ch.5 Claims Submission Methods

The two basic methods of submitting health insurance claims are (choose two);

A. Electronic B. Paper form

This new HIPAA standard version addresses man of the deficiencies in the former version and accommodates the reporting of (choose two)

A. National provider identifiers (NIPs) D. the new ICD-10 codes

The CMS-1500 from is an 8 1/2 X 11-inch, two-sided document, the front side of which is printed in:

A. OCR scannable red ink

Service or supplies that are appropriate and necessary for the symptoms, diagnosis, and treatment of the medical condition and meet the standards of good medical practice is the definition for:

A. medical necessity

An individual covered under Medicare is referred to as a(n):

B. Beneficiary

An insurance policy that covers an individual, his or her spouse, and eligible dependents is referred to as a(n):

B. Family plan

A modern innovation that has made claims submission faster, more accurate, and at a cost saving to a medical practice is:

B. Optical character recognition

A company that receives claims, consolidates them, and transmits them in batches to third-party payers is called a:

B. clearinghouse

The health insurance claims process is an interaction between the healthcare provider and a(n):

B. insurance company

The patient information form is considered a legal document and should be updated no less often than:

B. once a year

According to the text, the two methods of submitting electronic claims are (choose two)

B. through a claims Clearinghouse C. Directly to the insurance carrier

After January 2010, a new version of the HIPAA standards was implemented called:

B. version 5010

In no computerized practices, patients chargers and payments can be tracked manually on a(n):

C. patient ledger card

Medicare claims must be submitted electronically unless the Secretary of HHS grants a(n):

C. wavier

A "small provider" of services is one with hewer than:

D. 25 Full-time equivalent employees

An example of a method for a manual claims follow-up is using an:

D. A and C are correct

The standard unique identifier that was adopted to identify all healthcare providers and health plans is the:

D. NPI

A multipurpose from used by most medical practices for billing is called a(n):

D. all of the above

Identify which of the following is considered a HIPAA- covered entity.

D. all of the above

A patient's name. address, social security number, and employment data are commonly referred to as:

D. demographic information

HIPAA allows providers who conduct business electronically to use their own established healthcare transactions, code sets, and identifiers.

F

Roster billing of Medicare-coverage vaccinations for multiple beneficiaries must be submitted electronically.

F

The American medical association is responsible for creating the universal claim from known as the CMS-1500

F

The HIPAA Administrative Simplification Compliance Act (ASCA) prohibits the Department of Health Human Services (HHS) from paying all claims that are not submitted electronically, with exception.

F

The centers for Medicare and Medicaid services (CMS) initiated changed to promote uniformity in healthcare claim submission by adopting standards for electronic health information transactions.

F

The intent of HIPAA's Administrative Simplification legislation was to provide consumers with lower healthcare cost.

F

Practice management software allows users to enter patient demographic information, schedule appointments, maintain lists of insurance payers, perform billing tasks, and generate reports.

T

Small entity providers are those with 25 of fewer full-time employees (FTEs) and physicians, practitioners, and suppliers with 10 or fewer FTEs.

T

The CMS-1500 (originally known as the HCFA-1500) was developed for the purpose of submitting Medicare claims.

T

The health insurance professionals most important responsibility is to obtain the maximum amount of reimbursement in the minimal amount of time that the patients health record will support.

T