Assignment 15.1 Review Questions

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

direct links.

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

electronic data interchange (EDI).

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

encoder.

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.

encounter form.

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

encryption.

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

d. ANSI 835.

Today, most claims are submitted by means of:

d. EDI.

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:

d. Version 7030.

Uniform patient identifiers:

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

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

d. carrier direct entry.

Electronic claims are submitted by means of:

d. electronic data interchange (EDI).

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

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

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

d. per minute.

When computer software is upgraded, the health care organization must submit a batch of ____ to the insurance carrier to determine whether claims can be transmitted successfully.

test files.

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

No.

HIPAA's electronic standard transactions are identified by a four-digit number that precedes "ASC X12N."

False.

To look for and correct all errors before the health claim is transmitted to the insurance carrier, you _____ or _____.

- may print an insurance billing worksheet. - perform a front-end edit (online error checking).

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

False.

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

False.

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

2 weeks or less.

The family practice taxonomy code is

207Q00000X.

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.

5010.

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.

Administrative Simplification Enforcement tool.

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

False.

As International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes are deleted and become obsolete, they should immediately be removed from the practice's computer system.

False.

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

False.

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

False.

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

EOMP; Explanation of Medicare benefits.

A paper remittance advice is generated by Medicare when using ANSI 835 Version 5010.

False.

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

False.

The Claim Attachments Standards have not yet been adopted; however, it was mandated for compliance as of _____, as required under the Affordable Care Act.

January 1, 2016.

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

NPI (National Provider Identifier).

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 (ASET).

True.

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

True.

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

True.

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

True.

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?

Yes.

Refer to Table 15.3 in the textbook to complete these statements. a. The staff at College Clinic submit professional health care claims for each of their providers and must use the industry standard electronic format called ______ to transmit them electronically. b. The billing department at College Hospital must use the industry standard electronic format called _____ to transmit health care claims electronically. c. The Medicare fiscal intermediary (insurance carrier) uses the industry standard electronic format called ____ to transmit payment information to the College Clinic and College Hospital. d. It has been three weeks since Gordon Marshall's health care claim was transmitted to the XYZ insurance company and you wish to inquire about the status of the claim. The industry standard electronic format must be used to transmit this inquiry is called _____. e. Dr. Practon's 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.

a. ASC X12N 837P b. ASC X12N 837I c. ASC X12N 835 d. ASC X12N 276 e. ASC X12N 270

Refer to Table 15.2 in the textbook to name the standard code sets used for the following: a. Physician services _______ b. Diseases and injuries ______ c. Pharmaceuticals and biologics ______

a. Current Procedural Terminology code set. b. Classification of Diseases, Nineth Edition, Clinical Modification, Volume 1 & 2. c. National Drug codes for Retail Pharmacy transactions.

Refer to Table 15.4 in the textbook to name the levels for data collected to construct and submit an electronic claim.

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

Refer to Table 15.1 in the textbook to list benefits of using Health Insurance Portability and Accountability Act (HIPAA) standard transaction and code sets.

a. More reliable and timely processing -- quicker reimbursement from payer. b. Improved accuracy of data. c. Easier and more efficient access to information. d. Better tracking of transactions. e. Reduction of data entry and manual labor. f. Reduction in office expenses.

The online error-edit process allows providers to:

a. correct claim errors before transmission of the claim.

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

a. medical code sets.

The most important function of a practice management system is ____.

accounts receivable.

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

accredited standards committee X12.

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

c. 837P.

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:

c. EFT (Electronic Funds Transfer).

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

c. health plan identifier (HPID).

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 of the claims were automatically rejected and will not be processed is called a:

c. transaction transmission summary.

Under HIPAA transaction standard Accredited Standards Committee (ASC) X12 Version 5010, a ____ digit ZIP code is required to report service facility locations.

nine.

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

real time.

An electronic funds transfer (EFT) agreement may allow for health plans to ____ overpayments from a provider's bank account.

recoup.

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/an ____ number.

submitter.