Question 1

Trading Partner agreements are important because they

Accepted Answer

The answer of Trading Partner agreements are important because they
...

Question 2

Match between columns
                        Premises: Health Care Claim Payment/Advice
Health Care Services Review
Health Care Claim, Professional
Benefit Enrollment and Maintenance
Health Care Claim Status Request
Health Care Eligibility Benefit Inquiry
Health Care Claim Status Response

Accepted Answer

The Answer of ASC X12N 277 and ASC X12N 837 is...

Question 3

If the Office of HIPAA Standards finds noncompliance to the Transaction and Code Set Rule, they will expect to see a move toward compliance and improvement within

Accepted Answer

The answer of If the Office of HIPAA Standards finds...

Question 4

Electronic systems use a standard set of conventions to format data in an electronic communications. These systems are said to use standard communication ____________________.

Accepted Answer

The answer of Electronic systems use a standard set of...

Question 5

For a health care provider to comply with the Transaction and Code Set Rule, they must

Accepted Answer

To comply with the Transaction and Code Set Rule, health care providers must send claims to insurance plans using the ASC X12N format. This is a standard format for electronic data interchange that ensures consistency and accuracy in the transmission of healthcare data. Mailing forms via postal service with return receipt requested, receiving permission to send claims through fax machine, and writing insurance claims on special paper are not requirements for compliance with the Transaction and Code Set Rule.

Question 6

If the HIPAA Office finds that a trading partner has changed the formatting of a standard transaction, the office may report the partner to

Accepted Answer

The Office of E-Health Standards and Services is responsible for enforcing and maintaining standards for electronic transactions in healthcare, including HIPAA transactions. If a trading partner has changed the formatting of a standard transaction, they may be in violation of these standards and the Office of E-Health Standards and Services may take action.

Question 7

Physician service codes are

Accepted Answer

Physician service codes are known as Current Procedural Terminology (CPT) codes and are five-place codes that can include either all numbers or a combination of four numbers and one letter.

Question 8

A complaint relating to the Transaction and Code Set Rule might be about any of the following EXCEPT

Accepted Answer

The Transaction and Code Set Rule only pertains to the electronic transmission of healthcare transactions and the use of standardized codes. The disclosure of protected health information to an outside entity is governed by the Privacy Rule.

Question 9

Being sure the covered entity is using the proper HIPAA mandated transactions is the responsibility of

Accepted Answer

The primary responsibility of the HIPAA Officer is to ensure that the covered entity is in compliance with all HIPAA regulations, including the use of proper HIPAA mandated transactions. The software vendor may provide guidance on the use of their software, but it is ultimately the covered entity's responsibility to ensure compliance. The head physician and other staff members may have some responsibility in ensuring compliance, but the HIPAA Officer is ultimately responsible for overseeing all aspects of HIPAA compliance within the organization.

Question 10

The phrase "adjudicate a claim" means to

Accepted Answer

To "adjudicate a claim" means to process it for settlement, which involves reviewing, verifying, and deciding on the claim for payment or denial.

Question 11

The Accredited Standards Committee architecture of ASC X12N is the basic standard for

Accepted Answer

The answer of The Accredited Standards Committee architecture of ASC...

Quiz 3: Transactions and Code Sets