Deck 16: The Role of Computers in Health Insurance

Question 1

The electronic computer file that stores patients' health information is called:

A) direct data entry (DDE).
B) electronic funds transfer (EFT).
C) electronic medical record (EMR).
D) electronic remittance advice (ERA).

Answer 1

electronic medical record (EMR).

Question 2

One of the most important roles of the healthcare industry is _____ management.

A) drug
B) office
C) inventory
D) information

Answer 2

information

Question 3

The name of the system that electronically transfers data representing money between accounts or organizations is:

A) direct data entry (DDE).
B) electronic funds transfer (EFT).
C) electronic medical record (EMR).
D) electronic remittance advice (ERA).

Answer 3

electronic funds transfer (EFT).

Question 4

Data elements used to uniformly document the reasons why patients are seen and procedures or services provided to them during their healthcare encounters include:

A) identifiers.
B) code sets.
C) express data.
D) GEMs.

Question 5

To enroll in the Medicare (or other carrier)direct deposit program,the provider must contact the specific payer and ask for a/an:

A) identification number.
B) EFT enrollment form.
C) DDE questionnaire.
D) carrier-direct authorization.

Question 6

When a medical practice makes a decision to submit insurance claims electronically to a third-party payer,it must usually first go through a/an:

A) internal audit.
B) appeals process.
C) enrollment process.
D) background check.

Question 7

One of the main concerns of electronic medical records is:

A) software reliability.
B) training staff.
C) HIPAA regulations.
D) patient privacy.

Question 8

A physician,practitioner,facility,or supplier with fewer than 10 full-time equivalent employees can be considered a/an:

A) exempt source.
B) healthcare contributor.
C) small provider of services.
D) medical mandate.

Question 9

A type of business that receives insurance claims from multiple medical practices,consolidates them,and transmits them on to various insurance carriers is known as a/an:

A) EDI transmitter.
B) fiscal intermediary (FI).
C) claims clearinghouse.
D) claims consolidation firm.

Question 10

To reduce the number of forms and methods of completing claims and other payment-related documents and to use universal identifiers for providers of healthcare are two of the goals of:

A) CMS.
B) HHS.
C) ASCA.
D) HCFA.

Question 11

The process by which claims are submitted directly to the insurance carrier is called:

A) electronic claims transfer.
B) electronic submission.
C) electronic transmittal.
D) direct data entry.

Question 12

The acronym for the federal act that amended HIPAA,requiring all Medicare claims to be submitted electronically (except for certain circumstances),is:

A) HHS.
B) ARRA.
C) ASCA.
D) EMTLA.

Question 13

A standard format used to transfer information electronically between two entities is known as:

A) PHI.
B) EDI.
C) ICD.
D) DHS.

Question 14

All of the following are necessary for a medical practice to send claims electronically,except:

A) a printer.
B) a modem.
C) a computer.
D) HIPAA-compliant software.

Question 15

One of the chief concerns of electronic medical records (EMRs)is:

A) cost.
B) training capable staff.
C) keeping hardware/software up to date.
D) keeping patient information confidential.

Question 16

Identify which of the following is not one of the three main components of meaningful use.

A) The use of a certified EMR in a meaningful manner
B) The use of a certified EMR for electronic exchange of health information
C) The use of a certified EMR to submit clinical quality
D) The use of a certified EMR to collect delinquent patient accounts

Question 17

If the goal of a healthcare office is to migrate completely to an EMR system,a ___________ system may be a good choice.

A) combination records
B) digital imaging hybrid
C) mechanized
D) direct data entry

Question 18

To help improve the healthcare administrative process and,at the same time,simplify it,_____ was created.

A) CMS
B) DHS
C) HCFA
D) HIPAA

Question 19

The most cost-effective way of submitting claims when submitting primarily to one carrier is by using:

A) direct data entry (DDE).
B) a claims clearinghouse.
C) a fiscal intermediary (FI).
D) United States mail.

Question 20

The American Recovery and Reinvestment Act (ARRA)of 2009 provides reimbursement incentives to eligible professionals (EPs)and hospitals that meet "meaningful use" criteria of:

A) electronic medical records (EMRs).
B) ICD-10 coding changes.
C) HIPAA security standards.
D) National Provider Identifiers (NPIs).

Question 21

In order to qualify for Medicare/Medicaid's monetary incentives to put EMRs into operation,providers must demonstrate _________________ EMRs.

A) a significant need for
B) meaningful use of
C) adequate patient load for
D) they can afford

Question 22

Disadvantages to EMRs include all except which of the following?

A) Cost
B) Security breaches
C) Records transfer time
D) Lack of software available

Question 23

A physician,practitioner,facility,or supplier with fewer than 10 full-time equivalent (FTE)employees is called a/an _______________.

Question 24

The document that allows the provider's office to receive an explanation of benefits electronically is the ____________________.

Question 25

A ______________ sorts claims by payer and transmits them to the various insurance companies using the specific formats required by each.

Question 26

_________ include data elements used to uniformly document the reasons patients are seen and procedures or services provided to them during their healthcare encounters.

A) Code sets
B) NPIs
C) EINs
D) Fax codes

Question 27

With a/an _________________,payments can be posted automatically to patient accounts,allowing the health insurance professional to update accounts receivable much more quickly and accurately than if he or she had to post the payments manually.

Question 28

A service interruption in the mode of submitting the electronic claims that is outside of the control of the submitting facility is considered a/an _____________________________ under ASCA.

Question 29

Specific areas of administrative simplification addressed by HIPAA include all but which of the following?

A) EDI
B) Accreditation
C) Code sets
D) Specific identifiers

Question 30

An electronic file wherein patients' health information is stored in a computer system is called a/an _______________.

Question 31

Three methods of submitting claims electronically are ____________,________________,and ____________.

Question 32

The numbers used in the administration of healthcare to distinguish individual healthcare providers,health plans,employers,and patients are:

A) code sets.
B) identifiers.
C) EINs.
D) fax codes.

Question 33

A(n)_____ acts as an intermediary between the medical facility and the insurance carrier.

A) EFT
B) EDI
C) EMR
D) clearinghouse

Question 34

______ leads to faster data transfer,fewer errors,instant document retrieval,and less time wasted on exception handling,resulting in a more streamlined communication process.

A) EMR
B) EMC
C) EDI
D) ERA

Question 35

With certain exceptions,ASCA requires that all claims sent to the Medicare program on or after October 2003 be submitted:

A) in duplicate.
B) on CMS-1500 paper forms.
C) within 60 days.
D) electronically.

Question 36

Advantages to filing claims electronically include all of the following,except:

A) faster processing.
B) reduced denials.
C) increased payments.
D) immediate error notification.

Question 37

The record keeping method where some documents are stored electronically and some are kept in paper form is referred to as:

A) combination records.
B) blended registers.
C) sequenced accounts.
D) digital imaging hybrids.

Question 38

A hospital,skilled nursing facility,home health agency,or hospice with fewer than 25 FTEs is called a/an ______________.

Question 39

Standards for electronic healthcare transactions changed from Version 4010/4010A1 to Version 5010 in January of 2012,which accommodates the ______________ codes.

Question 40

The Secretary of HHS finds that a waiver of the electronic submission requirement is appropriate in the case of _____________.

Question 41

HIPAA regulations do not apply to the Medicare program because it is not considered a "health plan."

Question 42

Claims submitted via direct data entry (DDE)fall under the category of "other type of electronic claims" and are not subject to the "rule."

Question 43

_____are among the administrative simplifications addressed by HIPAA.Briefly explain the purpose of privacy standards in your own words.

Question 44

The use of standard transaction formats and code sets is required by CMS (formerly HCFA)for electronically transmitted health information from providers,health plans,and healthcare clearinghouses.

Question 45

____ and ____are two methods of submitting claims electronically.Briefly explain both.

Question 46

The Secretary of HHS grants a "waiver" for the electronic claims submission mandate for "unusual circumstances." Identify two of these "unusual circumstances."

Question 47

____are among the administrative simplifications addressed by HIPAA.Briefly explain the purpose of identifiers in your own words.

Question 48

One of the major obstacles in getting a medical practice set up for electronic claims submission is the time it takes to acquire approval from various state and federal agencies.

Question 49

List two concerns with electronic medical records.

Question 50

List at least four of the six ways computers are commonly used today from a health insurance perspective.

Question 51

According to ASCA,no other transactions (changes,adjustments,or appeals)to the initial claim are required to be submitted electronically.

Question 52

(EDI)is an administrative simplification addressed by HIPAA.Briefly explain EDI in your own words.

Question 53

____are among the administrative simplifications addressed by HIPAA.Briefly explain the purpose of security standards in your own words.

Question 54

____are among the administrative simplifications addressed by HIPAA.Briefly explain the purpose of code sets in your own words.

Question 55

Both providers and patients want assurances that data transferred electronically does not become vulnerable and fall into the wrong hands.

Question 56

Although EMRs may be the wave of the future,hackers ultimately may be able to penetrate EMRs despite security precautions.

Question 57

Effective October 2003,HIPAA made it mandatory (with few exceptions)that all Medicare claims be submitted electronically.

Question 58

Sum up the benefits of EDI.

Question 59

Patient accounting systems can be set up to receive automatic ERA payments.

Question 60

With the advent of HIPAA,specific federal guidelines are now in place that provide security and protection for all healthcare information transmitted electronically.

Question 61

A system wherein data representing money is moved electronically between accounts and organizations is called an EMR.

Question 62

A medical facility,physician,practitioner,or supplier with fewer than 10 FTEs is called a "small supplier."

Question 63

According to ASCA,no claim payment will be made under either Parts A or B of the Medicare program unless the claim is submitted electronically with a few exceptions.

Question 64

The digital imaging hybrid EMR system provides the best of both worlds- providing easy access of an electronic system but keeping paper records in case of computer problems.

Question 65

A "small provider" is a medical facility that has fewer than two practicing physicians.