Deck 8: The Electronic Claim

Question 1

When a medical practice has its own computer and transmits claims electronically directly to the insurance carrier, this system is known as

A) carrier-direct.
B) immediate response.
C) clearinghouse.
D) straight-line submission.

Answer 1

carrier-direct.

Question 2

A provider is not considered a covered entity under HIPAA under which of the following circumstances?

A) The provider has fewer than 10 employees and submits claims only on paper to Medicare.
B) If the provider submits electronic transactions to any payer.
C) If the provider submits paper claims to Medicare and has more than 10 employees.
D) None of the above.

Answer 2

The provider has fewer than 10 employees and submits claims only on paper to Medicare.

Question 3

ASC X12 Version 5010 allows providers to submit claims

A) with HCPCs codes, as needed.
B) with CPT-4, Category II, and Category III codes.
C) with ICD-10-CM/PCS codes.
D) with NPI numbers for referring physicians.

Answer 3

with ICD-10-CM/PCS codes.

Question 4

Incorrect sequencing of patient information on an electronic claim results in inaccuracies that violate the HIPAA standard transaction format and are known as

A) batch errors.
B) claim errors.
C) syntax errors.
D) HIPAA errors.

Question 5

Insurance claims transmitted electronically are usually paid in

A) 1 day.
B) 2 weeks or less.
C) 3-4 weeks.
D) 4-6 weeks.

Question 6

To ensure that data has been effectively backed up on the practice management system, verification of original records to stored information should be performed

A) daily.
B) weekly.
C) monthly.
D) annually.

Question 7

One advantage of electronic claim submission is the ability to build a/an ____ which provides a chronologic record of submitted data that can be traced to the source to determine the place of origin.

Question 8

A group of insurance claims sent at the same time from one facility is known as a

A) bundle.
B) group file.
C) batch.
D) package.

Question 9

Which of the following is the best way to protect computers and prevent data file damage during power outages?

A) All computers should be turned off prior to any type of storm.
B) All computers should be plugged into separate circuit breakers.
C) All offices should be equipped with a backup generator.
D) All offices should install uninterruptible power supplies.

Question 10

The HIPAA Security Rule addresses security of electronic PHI in which area?

A) Administrative safeguards
B) Technical safeguards
C) Physical safeguards
D) All of the above

Question 11

Back-and-forth communication between user and computer that occurs during online real time is called

A) electronic remittance notice.
B) interactive transaction.
C) electronic communication.
D) electronic data interchange.

Question 12

Data that is made unintelligible to unauthorized parties is referred to as

A) coded.
B) decoded.
C) encoded.
D) encrypted.

Question 13

The implementation of standard formats, procedures, and data content into the electronic data interchange process is the result of ______ regulations.

Question 14

The most important function of a practice management system is

A) electronic health records.
B) rescheduling.
C) accounts receivable.
D) word processing.

Question 15

A clearinghouse is a/an

A) regional office that "clears" the signal for electronic insurance claim transmission.
B) entity that receives transmission of insurance claims, separates the claims, and sends each one electronically to the correct insurance payer.
C) corporation hired by the insurance company to review claims for payment.
D) computer software system that can be purchased by the physician's office for electronic insurance claims transmission.

Question 16

Supplemental documents that provide additional medical information to a claim are referred to as

A) claim attachments.
B) advanced beneficiary notices.
C) claim reports.
D) add-on reports.

Question 17

A transmission report which identifies the most common reasons for claim denial is the

A) send and receive file reports.
B) scrubber report.
C) transaction transmission summary.
D) rejection analysis report.

Question 18

The employer's identification number is assigned by

A) the state.
B) the insurance company.
C) the Internal Revenue Service.
D) none of the above.

Question 19

The most common type of physical access control to limit access to areas where medical charts are kept is

A) locks on file cabinets.
B) locks on doors.
C) security alarms.
D) armed security staff.

Question 20

To maintain confidentiality, individuals should develop passwords composed of

A) more than three characters.
B) more than five characters.
C) more than five characters with upper- and lowercase characters.
D) more than 10 characters with upper- and lowercase characters.

Question 21

The upgrade to Version 5010 standards for electronic claims submission was required in 2012 to allow providers to submit either ___ or ___ code sets.

Question 22

A/an __ is a preprinted document used by the provider to circle procedural and diagnostic codes that are then passed on to the insurance billing specialist and used to enter information into the computer system.

Question 23

An internal audit that reviews who has access to PHI is a/an ___ safeguard or security measure.

Question 24

HIPAA requires employers to obtain ___ numbers to identify themselves during the process of enrolling employees into a health plan.

Question 25

___ allows third-party payers to deposit funds into the physician's bank account automatically and eliminates the need for personal handling of checks.

Question 26

An online transaction concerning the status of an insurance claim is called a/an ___.

Question 27

Medical data which are compiled and produced in the specific format used throughout the health care industry and sent in electronic files are HIPAA ___ transactions.

Question 28

A status report of claims is usually received ___.

Question 29

Under HIPAA, if a provider submits claims to Medicare and has 10 or more employees, the provider is considered a ___ and must comply with electronic transmission requirements to Medicare.

Question 30

For assignment of benefits, each patient's ___ must be obtained.

Question 31

Once a clearinghouse receives an electronic claims transmission, the first step is for claims to go through an editing process in which the claim is ___ for missing or incorrect information.

Question 32

An automatic logoff that prevents unauthorized users from accessing a computer is a/an __ safeguard.

Question 33

A screen prompt is a __.

Question 34

Why was the HIPAA Transaction Code Set developed?

Question 35

A digital subscriber line (DSL) is a high-speed connection used for data transmission that is accessed through a ____.

Question 36

Name three advantages of using a clearinghouse to bill insurance companies.

Question 37

A combination of letters, numbers, or symbols that each individual is assigned to access the computer system is called a/an ___.

Question 38

The three-digit standard transaction for transmission of the electronic claim is referred to in the physician's office as ___.

Question 39

Third-party payer claims examiners are forbidden from __ CPT and/or ICD-9 data that has been entered on a claim by the insurance billing specialist as health care providers are responsible for submitting an accurate bill.

Question 40

The establishment of standard unique patient identifiers is currently stalled due to protest that universal identifiers could be a ____ threat.

Question 41

Match the frequency with which each of the procedures described below should be done with the word correctly describing that frequency.

Review all claim rejection reports.

A)Daily
B)Weekly
C)End of month
D)Daily or weekly

Question 42

What is an encoder?

Question 43

Match the frequency with which each of the procedures described below should be done with the word correctly describing that frequency.

Batch, scrub, edit, and transmit claims.

A)Daily
B)Weekly
C)End of month
D)Daily or weekly

Question 44

List three additional names for an encounter form.

Question 45

Match the frequency with which each of the procedures described below should be done with the word correctly describing that frequency.

Research unpaid claims.

A)Daily
B)Weekly
C)End of month
D)Daily or weekly

Question 46

Match the frequency with which each of the procedures described below should be done with the word correctly describing that frequency.

Audit claims batched and transmitted with confirmation reports.

A)Daily
B)Weekly
C)End of month
D)Daily or weekly

Question 47

List the three ways in which clearinghouses are paid.

Question 48

Identify common claim attachments that provide additional medical information to a claims processor.

Question 49

Match the frequency with which each of the procedures described below should be done with the word correctly describing that frequency.

Make follow-up calls to resolve reasons for rejections.

A)Daily
B)Weekly
C)End of month
D)Daily or weekly

Question 50

Match the frequency with which each of the procedures described below should be done with the word correctly describing that frequency.

Correct rejections and resubmit claims.

A)Daily
B)Weekly
C)End of month
D)Daily or weekly

Question 51

What are the three kinds of information system safeguards and security measures?

Question 52

What does an electronic remittance advice (RA) do?

Question 53

Match the frequency with which each of the procedures described below should be done with the word correctly describing that frequency.

Post payments in practice management system.

A)Daily
B)Weekly
C)End of month
D)Daily or weekly

Question 54

Medicaid, Medicare, and TRICARE use which system to eliminate the need for a clearinghouse?

Question 55

Name the organization that is responsible for issuance and maintenance of National Provider Identifiers.

Question 56

Match the frequency with which each of the procedures described below should be done with the word correctly describing that frequency.

Note any problematic claims and resolve outstanding files.

A)Daily
B)Weekly
C)End of month
D)Daily or weekly

Question 57

What are medical code sets?

Question 58

Match the frequency with which each of the procedures described below should be done with the word correctly describing that frequency.

Update practice management system with payer information.

A)Daily
B)Weekly
C)End of month
D)Daily or weekly

Question 59

Match the frequency with which each of the procedures described below should be done with the word correctly describing that frequency.

Review clearinghouse/payer transmission reports.

A)Daily
B)Weekly
C)End of month
D)Daily or weekly

Question 60

List common electronic claim submission errors that have resulted from the upgrade to Version 5010 of the electronic claims submission standards.

Question 61

Clearinghouses always charge a flat fee for claim processing.

Question 62

The American Medical Association (AMA) developed the standards for electronic data exchange.

Question 63

The most important function of a practice management system is coding of claims for submission.

Question 64

Certain data elements are required when submitting a HIPAA standard transaction, whereas others are only necessary in specific situations.

Question 65

Encrypted data often look like gibberish to unauthorized users.

Question 66

The objective of HIPAA Transaction and Code Set regulations was to standardize code sets, claim forms, and processes used in health care facilities which would reduce administrative costs.

Question 67

CPT, ICD-9, and HCPCS codes are referred to as medical code sets and are standardized under HIPAA.

Question 68

For insurance claims to be submitted electronically, a signed agreement by the physician with the carriers involved is necessary.

Question 69

The 837P is the National Standard Format for electronic claims submission by physicians, which replaces the paper CMS-1500 form.

Question 70

Electronic remittance advices are sent to physicians following electronic funds transfer. However, the staff must still manually post payments to each individual patient's account.

Question 71

Health care providers were required to comply with electronic fund transfer rules by January 1, 2014.

Question 72

The National Provider Identifier identifies each individual health plan and is required on all claims as of May 23, 2007.

Question 73

The encounter form's procedure and diagnostic codes should be audited annually to determine if code changes have been made and if the form needs to be updated accordingly.

Question 74

A disadvantage of electronic claim submission is more time spent processing claims, which requires additional staffing.

Question 75

Confidential data should be stored only in the computer's hard drive.

Question 76

The exchange of data in a standardized format through computer systems is known as electronic data interchange.

Question 77

Practice management systems can be "rented" over the Internet.

Question 78

A batch of claims is a group of claims for different facilities which are sent to the same clearinghouse.

Question 79

Any provider who submits claims to Medicare is considered a covered entity.

Question 80

The newest version of electronic claims submission is known as 6020 and was required effective February 1, 2012.