Question 1

The organization that designates the standard names or nomenclatures for national standards is called

Accepted Answer

The American National Standards Institute (ANSI) is the organization responsible for designating the standard names or nomenclatures for national standards in the United States. The Centers for Medicare and Medicaid Services primarily oversee healthcare programs and regulations, the Accredited Standards Committee is involved in developing and publishing standards, and the Centers for Disease Control and Prevention focus on public health and disease prevention.

Question 2

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

Accepted Answer

Physician services codes, also known as Current Procedural Terminology (CPT) codes, are indeed five-place codes using all numbers or a combination of four numbers and one letter.

Question 3

The advantages of using electronic data interchange (EDI) are all of the following EXCEPT

Accepted Answer

It is not possible to completely avoid all errors in submission of claims, even with electronic data interchange. While EDI can reduce errors, there is still a potential for mistakes or system errors.

Question 4

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

Accepted Answer

The World Health Organization has indeed developed a tenth revision of the ICD codes, known as ICD-10. It was first published in 1992 and is currently used by many countries for clinical and research purposes.

Question 5

What is the name of the organization that developed the standard language that the DHHS adopted when they developed standard claims transactions?

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 6

Biologics are considered

Accepted Answer

Biologics are products derived from living organisms or contain components of living organisms, such as cells and tissues. They are used in medicine to treat various diseases, including cancer and autoimmune disorders.

Question 7

If the Office of HIPAA Standards finds a covered entity not willing to comply with the regulations of the Transaction and Code Set Rule, the Department of Justice may investigate criminal charges.

Accepted Answer

The Department of Justice can investigate and prosecute criminal violations of HIPAA, including willful neglect or refusal to comply with the regulations.

Question 8

Trading Partner agreements are not required by HIPAA.

Accepted Answer

The answer of Trading Partner agreements are not required by...

Question 9

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 10

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

The answer of HIPAA has accepted the use of Diagnostic...

Question 11

Implementation Guides for the standard transactions may be obtained from the

Accepted Answer

The Washington Publishing Company is the authorized distributor of the implementation guides for the standard transactions, as well as other HIPAA-related materials. The other options listed are involved in the development and maintenance of the standards but are not responsible for distributing the implementation guides.

Question 12

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 13

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

One Trading Partner agreement is not sufficient for all business partners. Each business partner must have their own unique agreement tailored to their specific relationship and exchange of protected health information with the covered entity.

Question 14

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

Accepted Answer

The use of ASC X12N standards allows for standardized formats for claims submission, making the process more streamlined and efficient.

Question 15

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

Accepted Answer

While the DHHS has encouraged healthcare providers to submit electronic claims, they have not eliminated paper claims without exception. Providers who are unable to submit electronic claims may still submit paper claims.

Question 16

The Accredited Standards Committee sets up templates for the transaction files. The structure is referred to as the _____ of the file.

Accepted Answer

The term "architecture" is commonly used in computer science to describe the structure or organization of a system, program, or file. Therefore, it is the most appropriate term to describe the structure of the transaction file established by the Accredited Standards Committee. The other answer choices ("shape", "database", and "source code") may be relevant in other contexts, but they do not accurately reflect the structure of the file in question.

Question 17

The two major categories of code sets endorsed by HIPAA are

Accepted Answer

The answer of The two major categories of code sets...

Question 18

With electronic claims, a crossover claim is

Accepted Answer

The answer of With electronic claims, a crossover claim is
...

Question 19

Trading Partner agreements are only for electronic standard transactions.

Accepted Answer

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

Question 20

The data string for a standard transaction may be compared to

Accepted Answer

A standard transaction data string is structured like a train, with a clear beginning (engine), middle (various size train cars), and end (caboose), representing the organized sequence of data elements.

Quiz 3: Transactions and Code Sets