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Exam 8: The Electronic Claim

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Question 21

Multiple Choice

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When a medical practice has its own computer and transmits claims electronically directly to the insurance carrier, this system is known as

A) carrier-direct.
B) immediate response.
C) clearinghouse.
D) straight-line submission.

E) A) and B)
F) B) and C)

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Question 22

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Clearinghouses always charge a flat fee for claim processing.

A) True
B) False

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Question 23

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Any provider who submits claims to Medicare is considered a covered entity.

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

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

Match the frequency with which each of the procedures described below should be done with the word correctly describing that frequency. -Batch, scrub, edit, and transmit claims.

A group of insurance claims sent at the same time from one facility is known as a

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

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

A combination of letters, numbers, or symbols that each individual is assigned to access the computer system is called a/an ___.

An internal audit that reviews who has access to PHI is a/an ___ safeguard or security measure.

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

Why was the HIPAA Transaction Code Set developed?

The upgrade to Version 5010 standards for electronic claims submission was required in 2012 to allow providers to submit either ___ or ___ code sets.

The 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.

To maintain confidentiality, individuals should develop passwords composed of

A batch of claims is a group of claims for different facilities which are sent to the same clearinghouse.

Encrypted data often look like gibberish to unauthorized users.

HIPAA requires employers to obtain ___ numbers to identify themselves during the process of enrolling employees into a health plan.

Certain data elements are required when submitting a HIPAA standard transaction, whereas others are only necessary in specific situations.