Question 1

Which of the following is the HIPAA-mandated electronic transaction for claims from physicians and other medical professionals?

Accepted Answer

The HIPAA-mandated electronic transaction for claims from physicians and other medical professionals is the 837P, where "P" stands for Professional.

Question 2

Determine what was not required of PMP vendors when the HIPAA 837 electronic transaction was mandated.

Accepted Answer

The HIPAA 837 electronic transaction mandate required PMP vendors to ensure their software could accommodate HIPAA-mandated transactions, maintain up-to-date software products, and train office personnel in the use of new features. However, it did not specifically require vendors to provide updates at no additional cost.

Question 3

Name the current paper claim approved by the NUCC.

Accepted Answer

The CMS-1500 (02/12) is the current paper claim form approved by the National Uniform Claim Committee (NUCC) for use by healthcare providers to bill Medicare carriers and durable medical equipment regional carriers.

Question 4

You are working at a practice and need to decide whether or not you may release a medical document about a patient in order to process a claim. Determine where to find this information on the CMS-1500.

Accepted Answer

Item Number 12 on the CMS-1500 form is where the patient authorizes the release of medical information necessary to process a claim.

Question 5

On a HIPAA claim, which of the following is assigned to a particular service being reported?

Accepted Answer

A line item control number is assigned to a particular service being reported on a HIPAA claim to uniquely identify each service or item billed.

Question 6

You are working at a medical practice and have been requested to resubmit a claim to replace one that was sent the previous week. Determine what claim frequency code should be applied to the claim.

Accepted Answer

Claim frequency code 7 is used for a replacement of a prior claim.

Question 7

In which of these methods of transmitting claims do providers and payers exchange transactions directly without using a third party?

Accepted Answer

Direct transmission to the payer involves providers and payers exchanging transactions directly without the use of a third party.

Question 8

What information about an accident is not required to be reported on the HIPAA 837 claim?

Accepted Answer

The name of the person who caused the accident is not required to be reported on the HIPAA 837 claim. The HIPAA 837 claim focuses on details about the accident relevant to the patient's treatment and insurance claims, not assigning blame or liability.

Question 9

The insured's ID number is the

Accepted Answer

The insured's ID number refers to the identification number of the policy holder, which is used to identify the individual in the insurance company's system.

Question 10

What type of code may not be required by HIPAA, but if used, must be chosen from the NUCC list?

Accepted Answer

The answer of What type of code may not be...

Question 11

The responsible party is held accountable for

Accepted Answer

The responsible party is typically the person or entity that is financially responsible for paying a bill.

Question 12

Correct administrative code sets for claims are those that are

Accepted Answer

Administrative code sets must be valid at the time the transaction is started to ensure that the claims are processed correctly and in compliance with current regulations.

Question 13

What is the most common method of claim transmission?

Accepted Answer

Clearinghouse use is the most common method for transmitting claims because it allows for the submission of claims to multiple payers through a single channel, streamlining the process and reducing errors.

Question 14

You are completing a CMS-1500 and realize that a husband has additional coverage under his wife's policy. Determine where you would record the wife's name on the CMS-1500 for the additional insurance.

Accepted Answer

Item Number 9 on the CMS-1500 form is designated for entering the name of the other insured when there is additional coverage, such as a spouse's insurance policy.

Question 15

Which of the following supplemental information can not be entered into the shaded areas of Item Number 24?

Accepted Answer

The shaded areas of Item Number 24 on medical claim forms are designated for specific types of supplemental information, such as narrative descriptions of unspecified codes, tooth numbers, and National Drug Codes (NDCs) for drugs. The provider's address does not belong in these shaded areas, as there are other designated places on the form for provider information.

Question 16

Identify the important step that immediately precedes claim transmittal.

Accepted Answer

Checking the claim is crucial to ensure all information is accurate and complete before transmittal to avoid delays or denials.

Question 17

Name the POS code used to indicate a procedure occurred in an on campus-outpatient hospital.

Accepted Answer

The POS code for an on-campus outpatient hospital is 22. This code is used in medical billing to specify the setting in which a service was provided.

Question 18

A payer requires the provider to list specific identifiers supplemental claim information on the CMS-1500. Determine the most likely place they would require this information to be reported.

Accepted Answer

Item Number 19 on the CMS-1500 form is designated for additional information that does not fit elsewhere on the form, making it the most likely place for a payer to require specific identifiers or supplemental claim information.

Question 19

Which of the following is a data element that is required on the HIPAA 837P claim?

Accepted Answer

The billing provider name and telephone number are required on the HIPAA 837P claim to identify the provider who is requesting payment. This information is crucial for processing the claim and ensuring that payment is made to the correct entity.

Question 20

The electronic transmission of claims is not required by law if a practice never sends any kind of electronic health care transactions, and has less than __________ full-time or equivalent employees.

Accepted Answer

Practices with fewer than ten full-time or equivalent employees are exempt from the requirement to electronically transmit claims under HIPAA regulations.

Quiz 7: Health Care Claim Preparation and Transmission