Deck 3: Transactions and Code Sets

Question 1

HIPAA has accepted the use of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV-TR) as a standard for mental disorder diagnoses.

Answer 1

False

Question 2

Use of the ASC X12N standards for standard transactions makes the administration of claims submission easier.

Answer 2

True

Question 3

Identify the choice that best completes the statement or answers the question.
The data string for a standard transaction may be compared to

A)a collage of many parts of a claim placed in random order.
B)a line of various size train cars with a header and trailer.
C)the rings of a tree with the most important part inside, surrounded by larger pieces of data.
D)complete gibberish nonsense that must be de-encrypted by a computer to be understood.

Answer 3

a line of various size train cars with a header and trailer.

Question 4

The World Health Organization developed a tenth revision of the ICD codes.

Question 5

In order to send accurate standard transmissions, everyone in a covered entity must be trained to know the standard transmission (or EDI) format.

Question 6

Trading Partner agreements are only for electronic standard transactions.

Question 7

One Trading Partner agreement is all that is necessary for the HIPAA Officer to write.It would be acceptable for any business partner that trades protected health information with them.

Question 8

Crossover claims encourage an automatic rejection from the secondary payer for any claim the primary payer has rejected.

Question 9

Identify the choice that best completes the statement or answers the question.
Trading Partner agreements are important because they

A)allow the partners to set up their own arrangement for electronic claims.
B)restrict the partners from setting up their own arrangements for electronic claims.
C)permit each partner to change the manner in which claims are submitted.
D)are regulated by the federal government to ensure that all partners agree.

Question 10

Regulating standard ASC X12N transactions, the DHHS has eliminated all paper claims without exception.

Question 11

Identify the choice that best completes the statement or answers the question.
If the Office of E-Health Standards and Services finds noncompliance to the Transaction and Code Set Rule, they will expect to see a move toward compliance and improvement within

A)20 days.
B)30 days.
C)60 days.
D)90 days.

Question 12

Trading Partner agreements are not required by HIPAA.

Question 13

Identify the choice that best completes the statement or answers the question.
The Accredited Standards Committee sets up templates for the transaction files.The structure is referred to as the _of the file.

A)architecture
B)shape
C)database
D)source code

Question 14

Identify the choice that best completes the statement or answers the question.
The two major categories of code sets endorsed by HIPAA are

A)drug and diagnosis codes.
B)procedure and diagnosis codes.
C)medical and nonmedical codes.
D)none of the above.

Question 15

Identify the choice that best completes the statement or answers the question.
If the HIPAA Office finds that a trading partner has changed the formatting of a standard transaction, the office may report the partner to

A)the Department of Justice.
B)the Office for Civil Rights.
C)the Department of Health and Human Services.
D)the Office of E-Health Standards and Services.

Question 16

Identify the choice that best completes the statement or answers the question.
What is the name of the organization that developed the standard language that the DHHS adopted when they developed standard claims transactions?

A)Health Level 7
B)Accredited Standards Committee
C)EDI Forum
D)American Medical Association

Question 17

Identify the choice that best completes the statement or answers the question.
A complaint relating to the Transaction and Code Set Rule might be about any of the following EXCEPT

A)code set received or sent and rejected.
B)noncompliant transaction received.
C)compliant transaction sent and rejected.
D)disclosure of protected health information to an outside entity.

Question 18

Physician services codes are five-place codes using all numbers or a combination of four numbers and one letter.

Question 19

Identify the choice that best completes the statement or answers the question.
Implementation Guides for the standard transactions may be obtained from the

A)Washington Publishing Company.
B)Department of Health and Human Services.
C)Designated Standard Maintenance Organization.
D)National Uniform Billing Committee.

Question 20

Identify the choice that best completes the statement or answers the question.
The advantages of using electronic data interchange (EDI) are all of the following EXCEPT

A)to avoid all errors in submission of claims.
B)to receive response and reimbursement for claims in a short amount of time.
C)to submit clean claims and know they will all be accepted by the health plan.
D)to save time and energy since mailing paper claims costs money.

Question 21

Identify the code with the name of the source document.

OB9J40Z

A)ICD-10-CM, Diagnosis
B)ICD-10-PCS, Hospital Procedures
C)CPT-4, Physician Procedures
D)CDT-4, Dental Procedures
E)HCPCS, Non-physician Procedures

Question 22

Identify the choice that best completes the statement or answers the question.
23 Being sure the covered entity is using the proper HIPAA mandated transactions is the responsibility of

A)the software vendor.
B)the head physician of the facility.
C)any member who works at the facility.
D)the HIPAA Officer.

Question 23

Match the name of the transaction standard with the ID number assigned.

Health Care Claim Payment/Advice

A)ASC X12N 270
B)ASC X12N 275
C)ASC X12N 276
D)ASC X12N 277
E)ASC X12N 278
F)ASC X12N 834
G)ASC X12N 835
H)ASC X12N 837

Question 24

Match the correct reference book to the appropriate types of codes.

Physician procedures

A)Medicare Level II codes - HCPCS
B)ICD-10-CM
C)ICD-10-PCS
D)CPT-4
E)CDT-4
F)NDC codes

Question 25

Identify the choice that best completes the statement or answers the question.
Physician service codes are

A)five-place codes using all numbers or a combination of four numbers and one letter.
B)only number codes using 3, 4, or 5 spaces.
C)seven-space codes using both letters and numbers.
D)number codes using two digits, a decimal, and one or two more digits.

Question 26

Match the correct reference book to the appropriate types of codes.

Dental procedures

A)Medicare Level II codes - HCPCS
B)ICD-10-CM
C)ICD-10-PCS
D)CPT-4
E)CDT-4
F)NDC codes

Question 27

Identify the code with the name of the source document.

P9014

A)ICD-10-CM, Diagnosis
B)ICD-10-PCS, Hospital Procedures
C)CPT-4, Physician Procedures
D)CDT-4, Dental Procedures
E)HCPCS, Non-physician Procedures

Question 28

Match the name of the transaction standard with the ID number assigned.

Health Care Claim, Professional

A)ASC X12N 270
B)ASC X12N 275
C)ASC X12N 276
D)ASC X12N 277
E)ASC X12N 278
F)ASC X12N 834
G)ASC X12N 835
H)ASC X12N 837

Question 29

Match the correct reference book to the appropriate types of codes.

Hospital procedures

A)Medicare Level II codes - HCPCS
B)ICD-10-CM
C)ICD-10-PCS
D)CPT-4
E)CDT-4
F)NDC codes

Question 30

Identify the choice that best completes the statement or answers the question.
The Accredited Standards Committee architecture of ASC X12N is the basic standard for

A)the health care industry.
B)the insurance industry.
C)the information technology industry.
D)the medical doctor's profession.

Question 31

Match the name of the transaction standard with the ID number assigned.

Health Care Claim Status Request

A)ASC X12N 270
B)ASC X12N 275
C)ASC X12N 276
D)ASC X12N 277
E)ASC X12N 278
F)ASC X12N 834
G)ASC X12N 835
H)ASC X12N 837

Question 32

Match the name of the transaction standard with the ID number assigned.

Benefit Enrollment and Maintenance

A)ASC X12N 270
B)ASC X12N 275
C)ASC X12N 276
D)ASC X12N 277
E)ASC X12N 278
F)ASC X12N 834
G)ASC X12N 835
H)ASC X12N 837

Question 33

Identify the choice that best completes the statement or answers the question.
The phrase "adjudicate a claim" means to

A)decide if the claim has sufficient information to be paid.
B)use software to "scrub" the claim for errors.
C)review the claim for medical necessity.
D)process the claim for settlement.

Question 34

Match the correct reference book to the appropriate types of codes.

Non-physician procedures

A)Medicare Level II codes - HCPCS
B)ICD-10-CM
C)ICD-10-PCS
D)CPT-4
E)CDT-4
F)NDC codes

Question 35

Match the name of the transaction standard with the ID number assigned.

Health Care Services Review

A)ASC X12N 270
B)ASC X12N 275
C)ASC X12N 276
D)ASC X12N 277
E)ASC X12N 278
F)ASC X12N 834
G)ASC X12N 835
H)ASC X12N 837

Question 36

Match the correct reference book to the appropriate types of codes.

Drugs and biologics

A)Medicare Level II codes - HCPCS
B)ICD-10-CM
C)ICD-10-PCS
D)CPT-4
E)CDT-4
F)NDC codes

Question 37

Match the correct reference book to the appropriate types of codes.

Diagnosis

A)Medicare Level II codes - HCPCS
B)ICD-10-CM
C)ICD-10-PCS
D)CPT-4
E)CDT-4
F)NDC codes

Question 38

Match the name of the transaction standard with the ID number assigned.

Health Care Eligibility Benefit Inquiry

A)ASC X12N 270
B)ASC X12N 275
C)ASC X12N 276
D)ASC X12N 277
E)ASC X12N 278
F)ASC X12N 834
G)ASC X12N 835
H)ASC X12N 837

Question 39

Identify the choice that best completes the statement or answers the question.
For a health care provider to comply with the Transaction and Code Set Rule, they must

A)mail forms via Postal Service with return receipt requested.
B)receive permission first to send claims through fax machine.
C)send claims to insurance plans using ASC X12N format.
D)write insurance claims on special paper.

Question 40

Match the name of the transaction standard with the ID number assigned.

Health Care Claim Status Response

A)ASC X12N 270
B)ASC X12N 275
C)ASC X12N 276
D)ASC X12N 277
E)ASC X12N 278
F)ASC X12N 834
G)ASC X12N 835
H)ASC X12N 837

Question 41

Identify the code with the name of the source document.

E78.5

A)ICD-10-CM, Diagnosis
B)ICD-10-PCS, Hospital Procedures
C)CPT-4, Physician Procedures
D)CDT-4, Dental Procedures
E)HCPCS, Non-physician Procedures

Question 42

Identify the code with the name of the source document.

J3490

A)ICD-10-CM, Diagnosis
B)ICD-10-PCS, Hospital Procedures
C)CPT-4, Physician Procedures
D)CDT-4, Dental Procedures
E)HCPCS, Non-physician Procedures

Question 43

Identify the code with the name of the source document.

76942

A)ICD-10-CM, Diagnosis
B)ICD-10-PCS, Hospital Procedures
C)CPT-4, Physician Procedures
D)CDT-4, Dental Procedures
E)HCPCS, Non-physician Procedures

Question 44

Identify the code with the name of the source document.

S52.501A

A)ICD-10-CM, Diagnosis
B)ICD-10-PCS, Hospital Procedures
C)CPT-4, Physician Procedures
D)CDT-4, Dental Procedures
E)HCPCS, Non-physician Procedures

Question 45

Identify the code with the name of the source document.

29125

A)ICD-10-CM, Diagnosis
B)ICD-10-PCS, Hospital Procedures
C)CPT-4, Physician Procedures
D)CDT-4, Dental Procedures
E)HCPCS, Non-physician Procedures

Question 46

Identify the code with the name of the source document.

D7110

A)ICD-10-CM, Diagnosis
B)ICD-10-PCS, Hospital Procedures
C)CPT-4, Physician Procedures
D)CDT-4, Dental Procedures
E)HCPCS, Non-physician Procedures