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.

Accepted Answer

HIPAA does not endorse or accept specific diagnostic manuals like the DSM-IV-TR; it focuses on protecting patient information and privacy.

Question 2

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

Accepted Answer

The ASC X12N standards are designed to simplify and promote uniformity in the electronic exchange of healthcare transactions, including claims submission, making the administration process more efficient.

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.

Accepted Answer

The data string for a standard transaction is best compared to a line of various size train cars with a header and trailer because it suggests a structured sequence with a beginning and an end, similar to how data is organized in a transaction.

Question 4

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

Accepted Answer

The World Health Organization (WHO) developed the tenth revision of the International Classification of Diseases (ICD-10), which was endorsed by the Forty-third World Health Assembly in May 1990 and came into use in WHO Member States starting in 1994.

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.

Accepted Answer

Training on the standard transmission (or EDI) format is not required for everyone in a covered entity; only those individuals who are responsible for handling and managing electronic transactions need to be trained on the specific requirements of EDI formats.

Question 6

Trading Partner agreements are only for electronic standard transactions.

Accepted Answer

The answer of Trading Partner agreements are only for electronic...

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.

Accepted Answer

Each Trading Partner Agreement must be tailored to the specific relationship and exchange of Protected Health Information (PHI) between the covered entity and its business associate to ensure HIPAA compliance.

Question 8

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

Accepted Answer

Crossover claims are designed to facilitate the billing process when a patient has coverage under more than one health insurance plan. They are automatically forwarded from the primary insurer to the secondary insurer. The secondary insurer then processes the claim based on the primary insurer's payment or denial, but a rejection from the primary does not automatically lead to a rejection from the secondary; the secondary payer will review the claim based on its own coverage policies.

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.

Accepted Answer

The answer of Identify the choice that best completes the...

Question 10

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

Accepted Answer

While the Department of Health and Human Services (DHHS) has heavily promoted and regulated the use of ASC X12N transactions for electronic healthcare transactions, it has not eliminated all paper claims without exception. There are still circumstances under which paper claims can be submitted, especially for providers who may not have the capability to submit electronic claims.

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.

Accepted Answer

The answer of Identify the choice that best completes the...

Question 12

Trading Partner agreements are not required by HIPAA.

Accepted Answer

Trading Partner agreements are not required by HIPAA because they are not considered to be covered entities under the HIPAA Privacy Rule.

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

Accepted Answer

The term "architecture" best describes the structured setup of transaction files by the Accredited Standards Committee, as it refers to the design and organization of the file's components.

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.

Accepted Answer

The answer of Identify the choice that best completes the...

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.

Accepted Answer

The Office of E-Health Standards and Services is responsible for enforcing compliance with HIPAA transaction and code set standards, so they would be the appropriate entity to report to if a trading partner changes the formatting of a standard transaction.

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

Accepted Answer

The Accredited Standards Committee (ASC) X12 is the organization that developed the standard language for electronic data interchange (EDI), which the Department of Health and Human Services (DHHS) adopted for healthcare claims transactions.

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.

Accepted Answer

The Transaction and Code Set Rule, part of HIPAA, specifically deals with the standardization of electronic transactions and code sets for healthcare information. It does not cover the privacy aspects, such as the disclosure of protected health information to outside entities, which falls under the Privacy Rule.

Question 18

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

Accepted Answer

Physician services codes, often referred to as Current Procedural Terminology (CPT) codes, are typically five characters long and can be a combination of numbers and letters, not exclusively all numeric.

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.

Accepted Answer

Washington Publishing Company is known for providing implementation guides for standard transactions, particularly in the healthcare industry.

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.

Accepted Answer

EDI does not avoid all errors in submission of claims; it reduces errors but cannot eliminate them entirely.

Quiz 3: Transactions and Code Sets

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.

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

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

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

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

Trading Partner agreements are only for electronic standard transactions.

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.

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

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

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

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

Trading Partner agreements are not required by HIPAA.

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.

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

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

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?

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

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

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

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