Deck 5: Claim Submission Methods

Question 1

The nine-digit federal tax identification number is commonly referred to as the:

A) SSN.
B) EIN.
C) NIP.
D) UCR.

Answer 1

EIN.

Question 2

Documents needed to generate an insurance claim include all of the following,except a:

A) patient information form.
B) patient insurance ID card.
C) patient's driver's license.
D) patient's health record.

Answer 2

patient's driver's license.

Question 3

ASCA has identified that providers with 25 or fewer full-time employees (FTEs)and physicians,practitioners,and suppliers with 10 or fewer FTEs should be referred to as:

A) ASCA units.
B) small providers.
C) qualifying entities.
D) roster billers.

Answer 3

small providers.

Question 4

A business entity that specializes in consolidating claims received from providers and transmitting them in batches to each respective third-party payer.

A) Clearinghouse
B) Third-party administrator
C) Small provider
D) Fiscal intermediary

Question 5

According to HIPAA,which of the following code sets is acceptable for the electronic transmission of healthcare data?

A) CPT-4 procedure codes
B) ICD-10 diagnosis codes
C) OCR codes
D) both a and b

Question 6

The paper claim form approved by the AMA Council on Medical Services,which was subsequently adopted by all government healthcare programs.

A) UB-04
B) Version 5010
C) HCFA-1500
D) AMA-1040

Question 7

Services 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.
B) demographic information.
C) principles of morality.
D) value-based medicine.

Question 8

For entities that choose to transmit claims electronically,__________________ or a clearinghouse is necessary to handle the conversion of data to meet HIPAA requirements.

A) an OCR scanner
B) a dial-up connection
C) a billing service
D) practice management software

Question 9

A very significant piece of legislation passed by Congress in 1996 that impacted healthcare and medical billing was the:

A) HIPAA.
B) HCFA.
C) COBRA.
D) OCR.

Question 10

Submitting insurance claims straight to a third-party payer is called:

A) editing.
B) direct claims submission.
C) clearinghouse/direct.
D) none of these; providers cannot submit claims directly to third-party payers.

Question 11

A claim that has no errors or omissions and can be processed without delays is called a _____ claim.

A) clean
B) direct
C) clearinghouse
D) small provider

Question 12

The two basic methods to submit claims electronically are:

A) fax modem and telephone.
B) clearinghouse and direct to insurer.
C) USPS mail and OCR scanner.
D) e-mail and wireless EDR.

Question 13

The multipurpose billing document used by many providers is called a/an:

A) superbill.
B) encounter form.
C) patient service slip.
D) all of the above

Question 14

Examples of technological advancements in enrollee verification include all,except the following:

A) interactive voice response systems.
B) OCR systems.
C) swipe terminals.
D) Internet-based eligibility check systems.

Question 15

The document on which patients' record their demographic and insurance information is the:

A) encounter form.
B) insurance log.
C) ledger card.
D) patient information form.

Question 16

The health insurance claims process is typically an interaction between the healthcare provider and:

A) the patient.
B) the patient's employer.
C) the healthcare provider.
D) an insurance company.

Question 17

Supplemental documents that provide additional information to the claims processor that normally cannot be included within the electronic claim format are called:

A) ancillary documents.
B) records attachments.
C) claim attachments.
D) certificates of necessity.

Question 18

Medicare claims must be submitted electronically,unless the HHS Secretary grants a/an:

A) waiver.
B) stipend.
C) special compensation.
D) extended waiting period.

Question 19

The most common format used for computer text files and on the Internet is:

A) OCR.
B) JAVA.
C) ASCII.
D) HTML.

Question 20

One category that may be exempt from mandatory electronic claim submission is a/an:

A) chiropractor.
B) oral surgeon.
C) small provider.
D) veterinarian.

Question 21

One of the recent technological advances that makes verification of patient insurance eligibility easier and faster is the:

A) digital systems locater (DSL).
B) interactive voice response (IVR).
C) optical character recognition (OCR) scanner.
D) American Standard Code for Information Interchange (ASCII).

Question 22

The primary objective of a health insurance professional is to:

A) verify the patient's personal information.
B) correctly complete a CMS-1500 (08-05) for every patient.
C) ascertain that the medical record is complete and correct.
D) submit "clean" claims.

Question 23

If the decision is made to go direct to the carrier,there will be multiple _______ that occur when a computer is programmed to automatically connect to another computer.

Question 24

The format required for completing paper claims so that it can be "scanned" is __________.

Question 25

CMS has published its rules for making electronic claims attachments in the:

A) NUBC instruction manual.
B) Federal Register.
C) GAO annual publication.
D) none of these; CMS does not publish such rules.

Question 26

The two basic methods for submitting claims electronically are _____________ and ___________________.

Question 27

Covered entities were required by law to conform to Version 5010,which replaced the HIPAA ASC X12 4010/4010A1 EDI transaction standard,as of

A) May 23, 2011.
B) January 1, 2012.
C) December 31, 2012.
D) June 30, 2012.

Question 28

Name the two entities that have the responsibility of updating and revising the CMS-1500 universal form?

Question 29

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

A) PHI.
B) EIN.
C) OCR.
D) NPI.

Question 30

The _________ may grant a waiver from the mandatory electronic claims submission rule.

Question 31

Which of the following is a function included in most practice management software that allows reports to be generated showing outstanding claims by date,by carrier,or by some other sorting function?

A) Coding
B) Report scanning
C) Third-party logistics
D) Claims tracking

Question 32

After the paper form has been completed according to the applicable payer guidelines,it should be ____________ to check for errors.

A) photocopied
B) coded
C) proofread
D) faxed to a clearinghouse

Question 33

Documents that are sometimes necessary to support the services and procedures reported on the claim are called ________________.

Question 34

After January 2012,a new version of the HIPAA Standards was implemented called:

A) 4010A1.
B) Version 5010.
C) Standard X12.
D) Version 4010/4010A1.

Question 35

The two main sections of the CMS-1500 are ____________ and ____________.

Question 36

HIPAA's new 5010 transaction standards only impact __________ claim submissions.

Question 37

If a medical facility has only one employee but is utilizing some type of electronic software,the office must be in compliance with HIPAA's privacy rules and regulations.This is referred to as the ___________ rule.

Question 38

HIPAA Standards Version ____ addresses many of the limitations in the former version and supports the reporting of national provider identifiers (NPIs)and the new ICD-10 codes.

A) 4010
B) 5010
C) ASCII X19
D) 4010A1

Question 39

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

A) Healthcare plans
B) Healthcare providers
C) Healthcare clearinghouses
D) All of the above

Question 40

The new HIPAA Standards version addresses many of the deficiencies in the former version and accommodates the reporting of:

A) National provider identifiers (NPIs).
B) the new CPT codes.
C) the new ICD-10 codes.
D) both a and c are correct

Question 41

What is meant by "assigning benefits"?

Question 42

If a claim is computer generated,there is no need for proofreading.

Question 43

Complete this statement: "A complete medical record should _______."

Question 44

Every insurance company has a unique identification card that it issues to its subscribers.

Question 45

The AMA developed the first CMS-1500 claim form for military use.

Question 46

What is the most important task the health insurance professional is responsible for?

Question 47

One way to track submitted claims is through the use of an insurance claims tracking form or "log."

Question 48

Name two advantages of filing claims electronically.

Question 49

List five common reasons why claims are rejected.

Question 50

The federal government mandates the use of a "universal" encounter form for all providers.

Question 51

HIPAA includes administrative simplification provisions that contain standards for electronic claims submission.

Question 52

What types of information are typically found on an encounter form?

Question 53

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

Question 54

Explain how claim attachments can be sent electronically using such software as FastAttach™.

Question 55

Small providers that are not computerized can use the paper version of the CMS-1500.

Question 56

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

Question 57

List the five documents needed for filing an insurance claim.

Question 58

Define a "small provider."

Question 59

Names,addresses,Social Security numbers,and employment information are referred to as demographics.

Question 60

What information can the health insurance professional typically find on a patient's insurance ID card?

Question 61

The insurance claim process begins when the health insurance professional submits the claim to the insurance processor.

Question 62

Failure to confirm a patient's insurance coverage can create a delay in payment or result in no payment at all.

Question 63

Direct claim submission is considered the best method if most claims are being sent to a single carrier.

Question 64

Additional software may be required to send claims directly to a third-party payer.

Question 65

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

Question 66

All electronic claims must be routed through a claims clearinghouse.

Question 67

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

Question 68

Guidelines for claim attachments are the same if the medical facility uses electronic claim submission.

Question 69

A claims clearinghouse is a company that receives claims from healthcare providers and consolidates them so that they can send one transmission containing batches of claims to each third-party payer.

Question 70

The HIPAA Administrative Simplification Compliance Act (ASCA)prohibits Medicare from paying claims that are not submitted electronically,with certain exceptions.